Metro Atlanta Ambulance Service
1120 Allgood Industrial Court
Marietta, GA 30066
Dispatch: 770.693.8480
Phone: 770.693.8484
Fax: 770.693.8481

Medicare Physician Certification Statement

The Physician Certification Statement (PCS) Form is written authorization from a Physician, Physician's Assistant, Nurse practitioner, Clinical Nurse Specialist, Discharge Planner or Registered Nurse signifying that transport by ambulance is medically necessary and the patient’s condition at the time of transport meets medical necessity requirements.

Medicare Insurance requires that a patient’s condition meet “Medical Necessity” requirements for transport by ambulance or they will not authorize payment. This means that transporting the patient by any other means is contraindicated by the patient’s condition at the time of transport. The Patient Care Report (PCR), along with a completed PCS Form, must clearly and accurately demonstrate medical necessity for an ambulance at the time of transport.

For all non- emergency ambulance transports, Section I, II and III of Physician Certification Statement must be completed, signed and dated by the patient’s authorized Physician and must be on file with the transporting agency prior to submission of a claim to Medicare for ambulance transportation.

Please contact MAAS Customer Service at 770-693-8412 for additional information about Medical Necessity Requirements or to confirm a patient has a current PCS Form on file.

pdfPhysician Certification Statement