US · guidance
CMS Pub. 100-04, ch. 32, § 350.2
Establishing an Emergency
Claims for emergency services must be accompanied by a physician's statement describing the nature of the emergency
and stating that the services were necessary to prevent the death, or the serious impairment of, the beneficiary. A
statement that an emergency existed is not sufficient. In addition, when inpatient services are involved, the statement
must include the date when, in the physicians' judgment, the emergency ceased.
The finding of whether the patient's condition required emergency diagnosis or treatment is ordinarily based upon the
physician's evaluation of the patient's condition immediately upon the beneficiary's arrival at the hospital.
However, the emergency nature of the situation may have been assessed by a physician who attended the patient where
the incident resulting in hospitalization occurred (for example, a heart attack or an automobile accident). In these cases,
the attending physician who ordered the hospitalization may substantiate the claim that emergency hospitalization was
necessary.
Most emergencies are of relatively short duration so that only one bill is submitted. Generally, only one physician's
statement is necessary. However, in the rare situation where an emergency continued over an extended period,
subsequent requests for payment must be accompanied by a physician's statement containing sufficient information to
indicate clearly that the emergency situation still existed. A statement that the emergency continued to exist is not
acceptable.
Additional information to support a finding that the services were emergency services from the physician, the hospital,
and others (e.g., the police department at the scene of an accident) may be requested.
Medical necessity can be documented by the physician on a CMS-l77l, Attending Physician's Statement and
Documentation of Medicare Emergency or by the beneficiary's medical records. The CMS-1771 can be obtained from:
Centers for Medicare & Medicaid Services
Forms Management Section
7500 Security Blvd.
Baltimore, MD 21244-1850
Or, the form can be downloaded from http://cms.hhs.gov/Medicare/CMS-Forms/CMS-Forms/CMS-Forms-List.html
History
(Rev. 3287, Issued: 06-30-15, Effective: 04-21-15, Implementation: 04-21-15)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
51d4efc8d6beb99bfd75bfe1e0cce09b15d9877f1cb3f9371bfa4c6e061db5c3
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