Physician Certification Statement

The physician’s certification statement (PCS) must support the assertion that ambulance transportation was reasonable and necessary and that the beneficiary’s medical condition supported the necessity of the ambulance transport.

When a PCS is required:

  • When the patient is a Medicare beneficiary.
  • For non-emergency, scheduled repetitive ambulance transports
  • For scheduled and unscheduled, non-emergency ambulance transports (non-repetitive) of a beneficiary who is a resident of a facility.

When a PCS is NOT required:

  • Emergency transports
  • Non-emergency ambulance transports for a beneficiary who, at the time of transport, is residing either at home or in a facility and is not under the direct care of a physician.

Can someone other than the physician sign the PCS form?

Yes, but only for non-repetitive transports, and only if the beneficiary’s physician is not available.  It may be signed instead by a physician assistant, nurse practitioner, clinical nurse specialist, registered nurse or discharge planner.

For repetitive transports, PCS forms must be signed by the beneficiary’s physician and dated no earlier than 60 days prior to the date of service.

NOTE: A PCS is not a guarantee of payment.  Medicare’s guidelines must still be met to ensure payment.  If Medicare denies the claim, a Letter of Medical Necessity from the beneficiary’s physician may be required to file an appeal, even if a PCS was previously obtained.

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