---
kind: "section"
citation: "45 C.F.R. § 149.440"
title: "45"
number: "149.440"
heading: "Balance billing in cases of air ambulance services."
url: "https://uscodex.org/cfr/45/149.440"
---

# §149.440. Balance billing in cases of air ambulance services.

- (a) **In general.** In the case of a participant, beneficiary, or enrollee with benefits under a group health plan or group or individual health insurance coverage offered by a health insurance issuer who is furnished air ambulance services (for which benefits are available under such plan or coverage) from a nonparticipating provider of air ambulance services, with respect to such plan or coverage, the provider must not bill, and must not hold liable, the participant, beneficiary, or enrollee for a payment amount for the air ambulance services furnished by the provider that is more than the cost-sharing amount for such service (as determined in accordance with 26 CFR [54.9817-1T(b)(1)](/cfr/26/54.9817-1T.md?p=b-1) and [(2)](/cfr/26/54.9817-1T.md?p=b-2), [29](/cfr/26/29.md) CFR 2590.717-1(b)(1) and (2), and § [149.130(b)(1)](/cfr/45/149.130.md?p=b-1) and [(2)](/cfr/45/149.130.md?p=b-2), as applicable).
- (b) **Applicability date.** The provisions of this section are applicable with respect to air ambulance services furnished during a plan year (in the individual market, policy year) beginning on or after January 1, 2022.

## Notes

### Authority

Authority: 42 U.S.C. 300gg-92 and 300gg-111 through 300gg-139, as amended.

### Source

Source: 86 FR 36970, July 13, 2021, unless otherwise noted.