Click HERE to download our tool for the 2023 Medicare Ambulance Fee Schedule Allowed Amounts by Zip Code. The spreadsheet will open in Protected View. Please click the Enable Editing Button. Enter the zip code of the pickup location for the patient in yellow box and press enter. All fee schedule amounts will populate. Other important information such as the Carrier ID, locality and urban, rural, or super rural will also appear.
Click HERE to v
Thanks for your interest in PWW Client Connect. The fee for this program will range from $500 - $1,000 per month. In order for us to determine a fee for your organization, we request the following information. Once we receive this information we will send you a customized agreement. If you have any additional questions, please contact us at clientconnect@pwwemslaw.com.
At PWW, our mission is simple: To provide the highest quality legal and consulting expertise to EMS agencies, public, private and nonprofit ambulance services, Mobile Integrated Healthcare organizations, EMS billing companies and any other organization connected to the EMS industry.
Our Medicare and Billing Forms have been used by organizations all throughout the USA. Take a look for yourself!
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Sample Ambulance Signature/Claim Submission Authorization Form (v2.2) |
Word | Instructions | |
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Physician Certification Statement (v2.0) |
Word | Instructions | |
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Sample Signature Attestation Statements (v1.1) |
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Sample Signature Logs (v1.2) |
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Sample Advance Beneficiary Notice of Noncoverage* |
Word | ||
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*Note: this is an official government form, only limited modification is permissible, and PWW makes no copyright claim over government works. |
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IMPORTANT: By clicking any of these links and/or downloading any of these documents, you agree to the Terms of Use spelled out below. DO NOT download any of these documents if you do not agree to these terms. If you download any documents, you agree to these Terms of Use.
Medicare and Billing-Related Forms: Any individual or entity who downloads or uses these documents or any modified version of any of these documents in any way is referred to as the "User." The documents made available for download on this site are sample forms and policies only, designed to assist ambulance services in complying with applicable requirements. These documents are not legal advice, and no attorney-client relationship is formed by their use. Unless otherwise noted, these documents are not official forms of any governmental agency and may not reflect requirements of state law where you live. User bears all responsibility for compliance with all applicable laws and regulations, and the User agrees that neither Page, Wolfberg & Wirth, LLC nor the individual designers of these documents are not responsible for their use, non-use or modification by any User. Do not use any of these documents or any modifications of them if you do not agree to the terms and conditions of this license. These documents may be modified by the User to meet the User's needs, though we bear no responsibility for any modifications. These documents are licensed only for use by individual ambulance services, and may not be sold or distributed by any other individual or entity. Any other use or distribution of these documents requires our express written permission. Please also note that we expect to periodically update these documents for various reasons, and we cannot be responsible to distribute new or updated forms to users. In addition, we do not guarantee that these documents will be updated to reflect new laws, regulations or other applicable authority. All documents are Copyrighted by Page, Wolfberg & Wirth, LLC, and any use, reproduction or distribution that is not in accordance with these Terms of Use is strictly prohibited unless permitted in writing by Page, Wolfberg & Wirth, LLC.
Page, Wolfberg & Wirth, LLC
5010 E. Trindle Road, Suite 202
Mechanicsburg, PA 17050
Phone: (717) 691-0100
Toll-free (877) EMS-LAW1 (877-367-5291)
To contact one of our team members, please visit our Professional Staff Page.
Please click HERE to access the handouts from the PWW Town Hall on the Elijah McClain Case presented on January 9, 2024.
PWW is proud of our twenty year history as the only law firm in the nation dedicated exclusively to EMS law.
