A doctor does not have to certify that your health requires ground ambulance transportation if it is an emergency. For non-emergency ground transportation, doctor certification may be needed. This depends on your circumstances.
If you want to schedule regular ambulance trips, your doctor must send the ambulance supplier a written order ahead of time. The order can be dated no earlier than 60 days before the trip.
For irregular or unscheduled or trips, your doctor must send a written order to the supplier within 48 hours if you are in a skilled nursing facility (SNF). If you are at home or in a facility where you are not under the direct care of a doctor, a doctor certification is not required.
Note: If you live in New Jersey, Pennsylvania or South Carolina, you or the ambulance supplier must also request prior authorization from the Medicare Administrative Contactor (MAC) before providing repetitive, non-emergency trips. This is in addition to getting your doctor’s orders for ambulance services. The MAC should make a decision about the request and send you and the supplier a notice within 10 business days of the request. If the request gets approved, Medicare will often end up covering the claim after your ambulance trip. However, if the request is denied, the supplier can keep resubmitting the paperwork to obtain prior authorization. If the problem cannot be corrected, there is only a small chance that Medicare will still end up paying for the claim should you get care. Contact your State Health Insurance Assistance Program (SHIP) for more information before you decide to use ambulance services if authorization is denied.