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Requirement of Physician Certification Statement for Ambulance Services

Requirement of Physician Certification Statement for Ambulance Services

Defining Physician Certification Statement

The Physician Certification Statement (PCS) is the written order certifying the medical necessity of non-emergency ambulance transports.

  • The regulations governing PCS requirements are specified in the Code of Federal Regulations at 42 CFR 410.40(d). These regulations are the basis for Medicare guidelines.
  • There is no specific Medicare-approved form for PCS. Regardless of the form you choose to use, the information on the form must comply with Medicare guidelines.

Required information on the PCS includes:

  • Patient’s name
  • Date(s) of ambulance transport
  • Patient’s medical problem/condition necessitating the ambulance transport. Information on the PCS must include a specific explanation as to why other means of transportation would endanger the patient’s health.
  • Signature of an authorized individual and the date signed. Note: Medicare requires that services provided/ordered be authenticated by the author. The signature for each entry must be legible and should include the practitioner’s first and last name. For clarification purposes, we recommend you include your applicable credentials (e.g., D.O. or M.D.).

Following individuals can sign the PCS for all other non-emergent transports:

  • The patient’s attending physician
  • If you are unable to obtain the physician’s signature, the following individuals may sign the PCS, provided that the person has personal knowledge of the beneficiary’s condition at the time the ambulance transport is ordered or the service is furnished, and the individual is employed by the beneficiary’s attending physician or by the hospital or facility where the beneficiary is being treated and from which the beneficiary is transported:
    • Physician assistant (PA)
    • Nurse practitioner (NP)
    • Registered nurse (RN)
    • Clinical nurse specialist (CNS) – where all applicable state licensure or certification requirements are met

Requirement of Physician Certification Statement

Ambulance providers are required by federal regulations (as per “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.

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