Transport Information


What we offer

At Sumner County EMS we are happy to provide for all your Emergency and Non Emergency transport needs. This page is to provide general information about our billing and insurance needs for patients transports. We currently offer stretcher transports for non ambulatory patients. This includes but not limited to Dr Appointments, discharges, special care transports, dialysis etc..

We are happy to file insurance on behalf of the patient to include TennCare, Medicare and Commercial Organizations.

In order to schedule a transport please note that the following conditions must be met.


Medicare (Traditional) does not pay for any transport, where the service could have been performed at the patient’s place of residency. For example if a Doctor could have visited the patient and performed the needed care, at the place of residency, then Medicare will not pay for transport to the Doctor’s office. This does not include specialty care items such as diagnostics tests, dialysis or other care that requires the patient’s physical presence.

If you are in doubt as to the coverage of a particular transport please contact our billing office at (615) 451-0429 extension 140.

All transports, regardless of insurance type, must have an ambulance Medical Necessity Form filled out and signed completely. As a convenience we have provided the MNF form below for download.

Tenncare / Private Insurance

TennCare and private insurance patients must have a prior authorization in place before scheduling your transport. We are NOT allowed to obtain these authorizations – the ordering physician/facility must request the prior authorization.

Physician’s Certification Statement (Medical Necessity Form)

Questions? Need Help?

quest1We understand that billing and insurance can be complicated.
Our Billing Specialist are highly trained and ready to assist with your questions and concerns.

Give us a call

For billing questions please call 615.451.0429 extension 140.
To schedule a transport during regular business hours, please call 615.451.0429 ext 113 (615.451.6070 after hours).

Online Billing Services


Transport Documents

forms Physician Certification for Ambulance Transportation Form

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.

As a convenience we have provided a copy for download using the link below

Physician’s Certification Statement (Medical Necessity Form)

npp Patient Privacy Forms
All patients should be provided with a Notice of Privacy Practice Form. As a convenience we have provided a copy for download using the link below.