Physician Certification Statement (PCS) For Non-Emergency Ambulance Transportation
Form Template
Out of medical necessity, patients may require non-emergency ambulance services for medical appointments or other medical services.
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The Physician Certification Statement (PCS) For Non-Emergency Ambulance Transportation app allows physicians to submit a request for prior authorization. To obtain ambulance service for a patient, the physician must supply the following information in the app: beneficiary information, transportation information, medical necessity information (and justification), and physician authorization. The Physician Certification Statement (PCS) For Non-Emergency Ambulance Transportation app also features an instructions page to give clarification when filling out the app.
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