A certification of medical necessity is required for all non-emergency transports. The physician certifies that the patient meets the necessary requirements to need a stretcher ambulance for transport. Medicare sets the medical necessity guidelines. The definition of” bed confined is a patient that is unable to get up from bed without assistance, ambulate and sit in a chair, including a wheelchair”. This includes transports from home, nursing home, physician’s office, and hospitals. Medical necessity is covered under your subscription if Medicare or private insurance does not pay this expense.