Ambulance Physician Certification Statement Guidelines
|Certification Required? Yes/No||Who May Sign the Certification||Timeframe||Other Information
scheduled, repetitive ambulance services
|Yes||Attending physician||The physician's order must be dated
no earlier than 60 days before the date the service is furnished.
ambulance services that are either unscheduled or that are scheduled on a nonrepetitive basis—
resident of a facility under a physician’s care
||The physician order must be obtained within 48 hours after the transport.||If the ambulance provider or supplier is unable to
obtain the required certification within 21 calendar days following the date of the service, the ambulance supplier must document its attempts to obtain the requested certification and may then submit the claim. Acceptable documentation includes a signed returned receipt from the U.S. Postal Service or other similar service that evidences that the ambulance supplier attempted to obtain the required signature from the beneficiary’s attending physician or other individual named above.
Physician Certification Statement Requirements
A PCS is required for the following ambulance services:
- Nonemergency, scheduled, repetitive ambulance services, and
- Unscheduled, nonemergency ambulance services or nonemergency ambulance services scheduled on a nonrepetitive basis for a resident of a facility who is under the care of a physician
Note: For nonemergency, scheduled, repetitive ambulance services, the physician’s order must be dated no earlier than 60 days before the date that the service is furnished.
A PCS is not required for the following ambulance services:
- Emergency; and
- Nonemergency, unscheduled ambulance services for a beneficiary who, at the time of the transport, was residing either at home or in a facility and who was not under the direct care of a physician.
If unable to obtain the physician’s signature, it is acceptable to obtain a signed certification statement from the physician assistant, nurse practitioner, or clinical nurse specialist (where all applicable state licensure or certification requirements are met), or discharge planner, who has personal knowledge of the beneficiary’s condition at the time that the ambulance transport is ordered or the service is furnished.
This individual must be 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.
For nonemergency ambulance services that are either unscheduled or that are scheduled on a nonrepetitive basis, providers/suppliers may submit a claim after 48 hours if a PCS or certification from an acceptable alternative person as described in 42 CFR Section 410.40(a) has been obtained, or after 21 days if acceptable documentation of attempts to obtain the certification has been obtained. This policy also applies in a situation where a provider/supplier responds to a nonemergency call and upon arrival at the point-of-pickup, the condition of the beneficiary requires emergency care.
Note: Although the condition of the beneficiary in this scenario would require the provider/supplier to concentrate on the emergent treatment of the patient upon arrival at the scene, the claim for this service would not qualify as an “emergency transport.”
When a PCS cannot be obtained in accordance with 42 CFR Section 410.40(a), a provider/supplier may send a letter via USPS Certified Mail with a return receipt proof of mailing or other similar commercial service demonstrating delivery of the letter as evidence of the attempt to obtain the PCS.