Categories of Ambulance Services

Ambulance services are divided into different levels of ground services based on the medically necessary treatment provided during transport. 

The ground services categories refer to both land and water transportation and are listed below: 

1. Basic Life Support (BLS) - Where medically necessary, the provision of BLS services as defined in the National EMS education and Practice Blueprint for the EMS – Basic, includes the establishment of a peripheral intravenous (IV) line.  (Therefore, the placement of and IV line alone does not qualify services for ALS payment.

2. Advanced Life Support, Level 1 (ALS1) – Where medically necessary, the provision of an assessment by an advanced life support (ALS) provider trained to the level of the EMT-Intermediate or Paramedic as defined in the National EMS Education and Practice Blue Print.  An ALS intervention is defined as a procedure beyond the scope of an EMT – Basic as defined in the National EMS Education and Practice Blueprint.  (In Georgia, and ALS provider is defined as a Cardiac technician or paramedic.) (Oxygen, cardiac monitor, IV).

3. Advanced Life Support, Level 2 (ALS2) – Where medically necessary, the administration of at least three different medications and/or provision of one or more of the following ALS procedures.

• Manual defibrillation/cardio version

• Endotracheal intubation

• Central venous line

• Cardiac pacing

• Chest decompression

• Surgical airway

• Intraosseous line

4. Specialty Care Transport (SCT) - Where medically necessary, in a critically injured or ill patient, a level of inter-facility services provide beyond the scope of the paramedic as defined in the National EMS Education and Practice Blueprint.  This is necessary when a patient’s condition requires ongoing care that must be provided by one or more health professionals in an appropriate specialty area, e.g., nursing, medicine, respiratory care, cardiovascular care, or a paramedic with additional training,  (In Georgia, this training should be beyond the scope of pre-hospital emergencies, and specifically address the clinical needs of patients being transferred between hospitals for a higher level of care not available at the sending hospital and training to operate and monitor equipment not normally used in that standard EMS operation.)

5. Non-emergency Transport – The term “non-emergency” refers to all scheduled transportation that does not meet the criteria for emergency, regardless of origin and destination.  By definition, hospital discharge trips, trips to and from ESRD facilities for maintenance dialysis, to and from other outpatient facilities for chemotherapy, radiation therapy, and other diagnostic and therapeutic services are scheduled runs, and therefore, are considered non-emergency services.

The following are conditions that could establish medical necessity for non-emergency ambulance transportation: 

• Patient has a major fracture (hip, vertebrae) which results in markedly impaired mobility: or

• Patient is in a body cast: or

• Patient has signs and symptoms of severe pain or distress or a medical condition or conditions that would be exacerbated by transport other than ambulance; or

• Patient must be transported by ambulance because of a specific physical condition or limitation that contraindicates transfer by wheelchair or other means.

Scheduled Ambulance Services Including Those furnished to End Stage Renal Disease (ESRD)

One of the problem areas in the growth of ambulance expenditures has been billings for non-emergency transportation that is not medically necessary, medically necessary transports to and from ESRD facilities for maintenance dialysis is scheduled, and therefore is non-emergency ambulance services.  In areas which require ALS vehicles by local ordinance, the transportation may be reported as ALS ambulance transportation.