Physician certification statements (PCS) are required for patients who are under the direct care of a physician and are required for:
Ambulance suppliers must obtain certification from the patient’s attending physician verifying the medical necessity of ambulance transportation in certain circumstances. The physician certification must be accurate and timely as it enables billing Medicare to receive payment for ambulance services.
The attending physician is responsible for supervising the medical care of the patient by:
Note: The signed PCS does not, by itself, demonstrate that the transport was medically necessary and does not absolve the ambulance provider from meeting all other coverage and documentation criteria.
PCS requirements for non-emergency scheduled repetitive ambulance transportation include the following:
Definition of Repetitive Ambulance Service:
If the ambulance provider is unable to obtain the PCS from the attending physician within 48 hours of transport, the provider may submit a claim if a certification has been obtained from one of the following who is knowledgeable about the patient’s condition and who is employed by either the attending physician or the facility to which the patient is admitted:
If unable to obtain the written order within the 48-hour limit, the supplier may submit the claim after 21 days if there is documentation of attempts to obtain the order and certification. When the PCS cannot be obtained in accordance with 42 CFR 410.40 the ambulance supplier may send a letter via U.S. Postal Service certified mail using the return receipt and/or proof of mailing or other similar service demonstrating delivery of the letter as evidence of the attempt to obtain the PCS.
CMS does not require a particular form or format for the certification and it can be simply a written statement that supports the need for ambulance services.
Novitas recommends that the form:
Note: A PCS is not required for emergency transports or for non-scheduled, non-emergency transports of patients residing at home or in facilities where they are not under the direct care of a physician.
The PCS must:
Local Coverage Determination, L35162 Ambulance Services (Ground Ambulance)