These guidelines should be used as a companion document to the official version of the ICD-10-PCS as published on the CMS website. The ICD-10-PCS is a procedure classification published by the …

Physician Certification Statement (PCS) for Ambulance Transport FACILITY REPRESENTATIVE - COMPLETE THIS FORM AND PROVIDE IT TO THE APPROPRIATE AMBULANCE SERVICE …

Medi-Cal requires a completed PCS form for all Non-Emergent Medical Transportation (NEMT) services. Please complete all fields to request NEMT services. Submit the completed form to Molina …

To meet this requirement, the patient must be either “bed confined” or suffer from a condition such that transport by means other than ambulance is contraindicated by the patient’s condition The following …

Physician Certification Statement (PCS) for Ambulance Transport FACILITY REPRESENTATIVE - COMPLETE THIS FORM AND PROVIDE IT TO THE APPROPRIATE AMBULANCE SERVICE …

All PCS providers, regardless of setting, use the DHB-3051 form. DHB-3051 is the only form that allows physicians to provide written attestation to the medical necessity for up to 50 additional PCS hours …

Information about the structure, organization, and appli-cation of ICD-10-PCS codes, along with reference material for coding with ICD-10-PCS, is provided in this manual.