The term “appropriate facilities” means that the institution is generally equipped to provide the needed hospital or
skilled nursing care for the type of illness or injury involved.
The fact that a more distant institution is better equipped, either qualitatively
or quantitatively, to care for the patient does not warrant a finding that a closer
institution does not have “appropriate facilities.”
An institution is not considered an appropriate facility if there is no bed available.
(The carrier presumes that there are beds available unless the claimant furnishes
evidence that none of the local institutions had a bed available at the time the ambulance
service was provided.)
Although ambulance service to a physician's office is not covered, there may be situations
when in the course of transporting a beneficiary to a hospital, the ambulance stops
at the physician's office because of the patient's dire need for professional attention
and immediately thereafter continues on to the hospital. Payment may be made for the
Transportation by ambulance to a hospital or SNF to obtain home health services not
available to the beneficiary in his home is covered only if the conditions in B. above