Land Ambulance: Physician Certification Statement (PCS) Requirements

Nonemergency, Scheduled, Repetitive Ambulance Services
CMS requirements for obtaining a Physician Certification Statement (PCS) for nonemergency, scheduled, repetitive ambulance services are contained in the Code of Federal Regulations, section 410.40(d)(2). The requirements are as follows:
(2) Special rule for nonemergency, scheduled, repetitive ambulance services. "Medicare covers medically necessary nonemergency, scheduled, repetitive ambulance services if the ambulance provider or supplier, before furnishing the service to the beneficiary, obtains a written order from the beneficiary’s attending physician certifying that the medical necessity requirements of paragraph (d)(1) of this section are met. The physician’s order must be dated no earlier than 60 days before the date the service is furnished."

In these situations, the PCS must be signed by the patient’s attending physician.

Other requirements for obtaining the PCS for nonemergency, scheduled, repetitive ambulance services remain in effect, including:
  • The PCS must be obtained before the ambulance supplier furnishes the ambulance service
  • The PCS must be dated no more than 60 days before the date the ambulance service is furnished
Requirements for Nonemergency, Unscheduled Ambulance Services and Nonemergency, Scheduled, Nonrepetitive Ambulance Services
  • The ambulance supplier must obtain a PCS before submitting the claim
  • The PCS can be obtained from the patient’s attending physician, up to 48 hours after the ambulance transport
  • If the ambulance supplier is unable to obtain a signed PCS from the patient’s attending physician, a signed certification statement may be obtained from one of the following authorized individuals:
    • Physician assistant (PA)
    • Nurse practitioner (NP)
    • Clinical nurse specialist (CNS)
    • Registered nurse (RN)
    • Discharge planner who has personal knowledge of the beneficiary’s condition at the time the ambulance service is ordered or furnished
  • Medicare regulations for PAs, NPs and CNSs apply, and all applicable state licensure laws apply
  • If the ambulance supplier is unable to obtain the required certification within 21 calendar days following the date of the transport, the ambulance supplier must document its attempts to obtain the requested certification and may then submit the claim. Acceptable documentation includes a signed return receipt from the U.S. Postal Service or other similar mail service that demonstrates that the ambulance supplier attempted to obtain the required signature from the beneficiary’s attending physician or other authorized individual.

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.

References

 

Contact Palmetto GBA JM Part B Medicare

Email Part B

Contact a specific JM Part B department

Provider Contact Center: 855-696-0705

TDD: 866-830-3188

Other Palmetto GBA Sites

Palmetto GBA Home

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Jurisdiction J Part A MAC

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Jurisdiction M Home Health and Hospice MAC

MolDX

National Supplier Clearinghouse MAC

PDAC

RRB Specialty MAC Providers

RRB Specialty MAC Beneficiaries

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