All ambulance transports must be medically necessary. Ambulance services to or from a hospital, critical access hospital (CAH), skilled nursing facility (SNF), from a hospital to a patient’s home, or to treatment (such as dialysis) is covered only when any other means of transportation would endanger a patient’s health.
Examples of qualifying conditions: contractures; danger to self/others; cardiac (requiring hemodynamic monitoring en route); confusion/combative/lethargic/comatose; orthopedic device (backboard/halo/use of pins in traction, etc.) requiring special handling during transport; third-party assistance/attendant required to apply, administer, regulate or adjust O2 en route; patient unable to maintain erect sitting position in a chair for time needed to transport; decubitus ulcers or other wounds on buttocks; morbid obesity; paralysis (hemi, semi, quad), non-healed fractures; IV med/fluids; DVT requiring elevation of a LE; moderate/severe pain on movement; restraints (physical or chemical); special handling/isolation. These are only common examples.
Physician Certification Statement (PCS) forms are required for all (1) non-emergency scheduled transports. These PCS forms may be completed and signed by a physician assistant, clinical nurse specialist, nurse practitioner, registered nurse, or discharge planner, (2) non-emergency repetitive scheduled transports (such as dialysis). These PCS forms MUST be signed by the patient’s physician, (3) certain non-emergency, non-scheduled ambulance services.
Medicare does not pay for a patient to be transported to a doctor’s office or clinic, regardless of medical necessity.
Rural/Metro Ambulance Company is a national leader in private ambulance services. From large hospital networks and healthcare systems to skilled nursing facilities, we are the trusted ambulance service for more than 750 hospitals and related facilities throughout the U.S.
Editor’s Note: This article was submitted by Jill Amburgey with Rural/Metro Ambulance. If you or your patient have questions regarding coverage for ambulance transportation or to schedule a transport, please call (205) 425-7911. www.ruralmetro.com.