What is a PCS form ambulance?

A Physician Certification Statement (PCS) is a written order certifying the medical necessity of non-emergency ambulance transports. Centers for Medicare and Medicaid Services (CMS) requires a PCS for both scheduled and unscheduled non-emergency ambulance transports for patients under the direct care of a physician.

How long is a PCS form good for?

This authorization must be completed and signed by the attending physician for scheduled repetitive transports. PCS form is good for 60 days only if signed by attending physician.

Does Medicare pay for transportation?

Original Medicare (Part A and Part B) generally does not cover transportation to get routine health care. However, it may cover non-emergency ambulance transportation to and from a health-care provider.

What is a 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.

What is the definition of bed confined as per Medicare?

A beneficiary is bed-confined if he/she is: • Unable to get up from bed without assistance; • Unable to ambulate; and • Unable to sit in a chair or wheelchair.

How does Medicare define a PCS?

Physician certification statements (PCS) are required for patients who are under the direct care of a physician and are required for: Scheduled non-emergency ambulance transports. Unscheduled non-emergency ambulance transports.

What is Medicare recertification?

Stay up-to-date in Medicare’s systems and reply promptly to program notices to prevent a gap in certification.

What part of Medicare covers transportation?

Medicare Part B
Yes, Medicare Part B may cover medically necessary transportation ordered by a doctor, and Medicare Part A may cover emergency transportation. However, Medicare Part A and B do not cover non-emergency transportation to and from your doctor’s office.

Does Medicare cover ambulance response and treatment no transport?

The Medicare ambulance benefit is a transportation benefit and without a transport there is no payable service. When multiple ground and/or air ambulance providers/suppliers respond, payment may be made only to the ambulance provider/supplier that actually furnishes the transport.

Do you have to have a PC for Medicare?

Transports provided while no PCS is on file with the ambulance provider are not covered by Medicare. Failure to have the PCS on hand prior to transport means that the transport is not covered by Medicare. Claims should not be submitted to Medicare for payment.

What are the requirements for Medicare and Medicaid?

Federal regulation 42 CFR 410.40 (COVERAGE OF AMBULANCE SERVICES) specifies how ambulance services are billed to Medicare/Medicaid, including the requirements for a “Physician Certification Statement” — better known as a PCS document.

Is the ambulance PC form covered by Medicare?

Non-emergency, Repetitive Patients – Ambulance PCS form: Transports provided while no PCS is on file with the ambulance provider are not covered by Medicare. Failure to have the PCS on hand prior to transport means that the transport is not covered by Medicare. Claims should not be submitted to Medicare for payment.

When to apply for Medicare priority medical claims?

The PCS must be obtained prior to submitting a claim to medicare, but no more than 48 hours after the transport was provided. If the physician will not or can not sign the PCS, a signed certification statement may be obtained from one of the following clinicians.