In some areas, transportation by airplane may qualify as covered ambulance service
      when:
   
   
   
      - 
         
            A.  
               The point of pickup is inaccessible by land vehicle;  or  
 
 
- 
         
            B.  
               Great distances or other obstacles are involved in getting the patient to the nearest
                  hospital with appropriate facilities and speedy admission is essential: i.e., in cases
                  where transportation by land ambulance is contraindicated;  and  
 
 
- 
         
            C.  
               All other conditions for coverage in HI 00610.250 are met. The first two conditions could be met in Hawaii, Alaska, and other remote
                  or sparsely populated areas of the continental United States.
                
 
 
Any ambulance service can be covered in the relatively rare instances where the beneficiary's
      condition and the other circumstances of the case necessitate the use of this transportation.
      However, where land ambulance service would suffice, payment is based on the amount
      payable for land ambulance.