Medical Policy Update

New Medical Policy

Non-Urgent Air Ambulance Transport

Effective Date:  3/9/2026
Preauthorization Required:  Yes
Policy Statement:

Purpose 
Blue Cross and Blue Shield of Nebraska has established this policy to better streamline the process for obtaining non-urgent air ambulance transport for patients, steerage to in-network providers (if possible), and negotiate rates prior to the transport. Emergent air ambulance transport is not addressed in this policy. 

Description 
Non-urgent air ambulance transport is defined as a planned transport of a medically stable patient by air whether jet, fixed wing or helicopter from an airport or inpatient facility to another airport or accepting facility for the purpose of medical treatment. 

Benefits for Ambulance Services are not available solely for the convenience of the Covered Person, family or provider, or if a less intensive level of transportation is medically appropriate, including ground transport or commercial airline. 

Authorization Requirements 
All non-urgent or planned air ambulance transport of patients will require preauthorization. 

Availability depends on benefit language.

Full medical/clinical details regarding the medical necessity of the transport must be provided. 

Policy 

1. Non-emergency air ambulance transportation from a Health Care Facility/Hospital Emergency Department or Inpatient Setting to an equivalent or higher level of acuity facility may be considered medically necessary when all the following criteria are met:
   1. The patient requires acute inpatient care; AND 
   2. The patient requires services that are unavailable at the originating facility; AND 
   3. The receiving hospital is the nearest one with the required capabilities; AND 
   4. The patient cannot be safely discharged from inpatient setting; AND 
   5. The patient cannot be reasonably and safely transported using other modes of transportation (ground ambulance, commercial air transport). 
2. Non-emergency air ambulance transportation services provided primarily for the convenience of the patient, the patient’s family/caregivers or physician, or the transferring facility, including situations where long distances exist between the transferring and receiving facilities, are considered not medically necessary.