Medicare Add-Ons Extended for 23 Months

The temporary Medicare ambulance add-on payments of 2% urban, 3% rural, and 22.6% super rural have been extended for 23 months from January 31 to December 31, 2027. While there was a three-day lapse in the ambulance add-ons, there should be no issue with Medicare payments due to the mandatory claims hold period of ten days. CBO estimates that the extension will provide $197 million in continued relief to ground ambulance service organizations.

The Consolidated Appropriations Act 2026 (H.R. 7148), which President Trump signed into law on Tuesday, included the extension. H.R. 7148 primarily funded the Department of Health and Human Services (HHS) and four other federal departments through the end of the fiscal year and the Department of Homeland Security through February 13. The bill also included report language directing the Administration for Strategic Preparedness and Response (ASPR) to make addressing the EMS workforce shortage a priority.

The ambulance extension language in H.R. 7148 closely follows the language of the House version (H.R. 2232) of the Protecting Access to Ground Ambulance Services Act and the timeframe of the Senate version (S. 1643) of the bill.