skip to content
Thank you for visiting First Coast Service Options' Medicare provider website. This website is intended exclusively for Medicare providers and health care industry professionals to find the latest Medicare news and information affecting the provider community.
To enable us to present you with customized content that focuses on your area of interest, please select your preferences below:
Select which best describes you:
Select your location:
Select your line of business:
This website provides information and news about the Medicare program for health care professionals only. All communication and issues regarding your Medicare benefits are handled directly by Medicare and not through this website. For the most comprehensive experience, we encourage you to visit Medicare.gov or call 1-800-MEDICARE. In the event your provider fails to submit your Medicare claim, please view these resources for claim assistance.
Join eNews       En Español
Text Size:
YouTube LinkedIn Email Print
Send a link to this page
[Multiple email adresses must be separated by a semicolon.]
Last Modified: 1/4/2022 Location: FL, PR, USVI Business: Part A, Part B

Checklist: Ambulance services documentation

This checklist is intended to provide health care providers with a reference for use when responding to additional documentation requests for emergency ambulance transports. Health care providers retain responsibility to submit complete and accurate documentation. Providers should refer to the CMS official website for additional information regarding ambulance transports and Medicare coverage at http://www.cms.gov/center/ambulance.aspexternal link

Check
Emergent ambulance documentation requirements
 
Documentation includes the signature and credentials of the professional responsible for the transport and care of the beneficiary during the transport.
 
Documentation to support the medical necessity for the emergent ambulance transport and why other means of transportation are contraindicated.
 
Documentation supports the type of emergent ambulance transportation and appropriate qualified attendants.
Check
Non-Emergent ambulance documentation requirements
 
The Physician Certification Statement (PCS) is complete, legible, signed and dated with physicians credentials. PCS needs to be renewed every 60 days for non-emergent repetitive services.
 
Documentation to support the medical necessity for the non-emergent repetitive ambulance transport and why other means of transportation are contraindicated.
 
For hospital-to-hospital transports, the record should clearly indicate precise treatment and/or procedure, date and legible identity of the observer, certification and rationale of necessity for non-emergent transfers.
 
For non-emergency transport, the record should clearly indicate the reason for the transport, what medical monitoring was performed and why other means of transportation was contraindicated.
Check
Important to both Emergent and Non-Emergent documentation
 
Documentation is for the correct beneficiary and date of service.
 
Documentation contains signature of beneficiary or their authorized representative.
 
Documentation supports total, actual mileage and includes the origin to the destination street addresses.
 
Evidence that an advanced beneficiary notice of non-coverage was provided to the beneficiary, if applicable.
 
Documentation supports necessity for transport to facility, other than nearest facility, if applicable.
First Coast Service Options (First Coast) strives to ensure that the information available on our provider website is accurate, detailed, and current. Therefore, this is a dynamic site and its content changes daily. It is best to access the site to ensure you have the most current information rather than printing articles or forms that may become obsolete without notice.