Tuesday, October 26, 2010

Physician Certification Statement (PCS) Requirements and repetitive ambulance services

Physician Certification Statement (PCS) Requirements

A Physician Certification Statement (PCS) is a written order that certifies the need for ambulance transportation. The certification itself is not the sole factor used in determining whether payment for ambulance services will be allowed. Ambulance services must meet all other coverage criteria in order for payment to be made.

Non-emergency ambulance services are categorized as scheduled or non-scheduled. A physician certification statement (PCS) is required for all:

• Non-emergency repetitive scheduled transports (must be signed by the patients MD)
• Non-emergency, non-repetitive scheduled transports; and
• Certain non-emergency non-scheduled ambulance services.

Repetitive Ambulance Services

A repetitive ambulance service is defined as medically necessary ambulance transportation that is furnished three or more times during a 10-day period or at least once per week for at least three weeks. Dialysis and respiratory therapy are types of treatments for which repetitive ambulance services are often necessary. However, the requirement for submitting the PCS form for non-emergency repetitive, scheduled, ambulance services is based on the quantitative standard (three or more times during a ten-day period or at least once per week for at least three weeks). Similarly, regularly scheduled ambulance services for follow-up visits, whether routine or unexpected, are not “repetitive” for purposes of the requirement unless one of the quantitative standards is met.

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