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Printed Date: 9/22/2015
Ambulance providers are required by federal regulations (Code of Federal Regulations, §410.40, Coverage of Ambulance Services) to obtain a physician certification statement (PCS) from the attending physician for non-emergency ambulance trips (scheduled or non-scheduled) before submitting a claim to Medicare. A PCS is required in advance for non-emergency scheduled or repetitive ambulance services. The date on the PCS can be no more than 60 days prior to the date the ambulance transportation occurs.
The information on the PCS is used to help establish the medical necessity for the ambulance transportation, although it is not the only criterion. Under Medicare guidelines, ambulance transportation must be medically necessary and reasonable. Medical necessity is established when the patient’s condition is such that use of any other method of transportation is contraindicated, meaning transportation by other means would endanger the individual’s health. Vague and general information is of little or no value. Past medical conditions may contribute to the need for the ambulance transportation but are not sufficient alone to justify that transport. Detailed information specific to the patient at the time the ambulance was ordered or the transport was furnished is needed to determine the medical necessity.
What is a Physician Certification Statement?
The Physician Certification Statement (PCS) is the written order certifying the medical necessity of non-emergency ambulance transports.
What information must be on the PCS?
Who may sign the PCS for all other non-emergent transports?
What else should you know about the PCS?
When is a PCS required?
May be obtained up to 48 hours after the service is furnished. If unable to obtain PCS within 21 calendar days following date of transport, document attempts to obtain the PCS, then submit claim.
Acceptable documentation includes a signed return receipt from the U.S. Postal Service or other similar commercial service demonstrating delivery of the letter as evidence of the attempt to obtain the PCS.
Refer to the text of this article for more information.
(Acceptable documentation includes a signed return receipt from the U.S. Postal Service or other similar commercial service demonstrating delivery of the letter as evidence of the attempt to obtain the PCS.)
In all cases, the ambulance supplier must keep appropriate documentation and present it upon request. If upon request, the medical record does not contain a valid PCS or documentation of the attempt to obtain it, the ambulance service will be denied. The presence of the signed certification statement or signed returned receipt does not alone demonstrate that the ambulance transport was medically necessary. All other program criteria must be met in order for payment to be made.
Proof of Mailing When a PCS Cannot be Obtained
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Last Updated: 05/23/2018