Non Emergenty Transportation providers
Claims for transportation services provided on or after September 1st, 2010, that meet the definition of non-emergency medical transportation, must be authorized by and submitted to American Medical Response (AMR) for payment. This covers the following service codes; A0100, A0110, A0140, A0170, A0180, A0190, A0200, A0210, S0215, T2003, T2004.
Claims for transportation services that meet the definition of non-emergency medical transportation provided prior to September 1st, 2010, must be submitted to Molina Medicaid Solutions for payment. This covers the following service codes; A0100, A0110, A0140, A0170, A0180, A0190, A0200, A0210, S0215, T2003, T2004 as well as service codes listed in table below.
Service HCPCS Description PA Required Modifier Place of Service
Individual Transportation
Non-emergency transportation, per mile A0080 Aged and Disabled (A&D) or Developmental Disabilities (DD) Waiver non-medical transportation, per mile, as authorized by Regional Medicaid Services. 1 Unit = 1 Mile. Maximum allowable of 1,800 waiver miles per year. Yes No POS 99
Attendant salary T2001 Non-emergency transportation, patient attendant/escort (salary). Spouse or parent of a minor child cannot be paid as attendant. 1 Unit = 15 Minutes. Yes No POS 99
Agency Transportation
Non-emergency transportation, per mile A0080 Aged and Disabled (A&D) or Developmental Disabilities (DD) Waiver non-medical transportation, per mile, as authorized by Regional Medicaid Services. 1 Unit = 1 Mile. Maximum allowable of 1,800 waiver miles per year. Yes No POS 99
Attendant salary T2001 Non-emergency transportation, patient attendant/escort (salary). Spouse or parent of a minor child cannot be paid as attendants. Yes No POS 99
Commercial Transportation
Non-emergency transportation, per mile A0080 Aged and Disabled (A&D) or Developmental Disabilities (DD) Waiver non-medical transportation, per mile, as authorized by Regional Medicaid Services. 1 Unit = 1 Mile. Maximum allowable of 1,800 waiver miles per year. Yes (First Trip, No modifier) (Subsequent trips, same day, Modifier 76 required) POS 99
Attendant salary T2001 Non-emergency transportation, patient attendant/escort (salary). Spouse or parent of a minor child cannot be paid as attendants. Yes No POS 99
Claims for transportation services provided on or after September 1st, 2010, that meet the definition of non-emergency medical transportation, must be authorized by and submitted to American Medical Response (AMR) for payment. This covers the following service codes; A0100, A0110, A0140, A0170, A0180, A0190, A0200, A0210, S0215, T2003, T2004.
Claims for transportation services that meet the definition of non-emergency medical transportation provided prior to September 1st, 2010, must be submitted to Molina Medicaid Solutions for payment. This covers the following service codes; A0100, A0110, A0140, A0170, A0180, A0190, A0200, A0210, S0215, T2003, T2004 as well as service codes listed in table below.
Service HCPCS Description PA Required Modifier Place of Service
Individual Transportation
Non-emergency transportation, per mile A0080 Aged and Disabled (A&D) or Developmental Disabilities (DD) Waiver non-medical transportation, per mile, as authorized by Regional Medicaid Services. 1 Unit = 1 Mile. Maximum allowable of 1,800 waiver miles per year. Yes No POS 99
Attendant salary T2001 Non-emergency transportation, patient attendant/escort (salary). Spouse or parent of a minor child cannot be paid as attendant. 1 Unit = 15 Minutes. Yes No POS 99
Agency Transportation
Non-emergency transportation, per mile A0080 Aged and Disabled (A&D) or Developmental Disabilities (DD) Waiver non-medical transportation, per mile, as authorized by Regional Medicaid Services. 1 Unit = 1 Mile. Maximum allowable of 1,800 waiver miles per year. Yes No POS 99
Attendant salary T2001 Non-emergency transportation, patient attendant/escort (salary). Spouse or parent of a minor child cannot be paid as attendants. Yes No POS 99
Commercial Transportation
Non-emergency transportation, per mile A0080 Aged and Disabled (A&D) or Developmental Disabilities (DD) Waiver non-medical transportation, per mile, as authorized by Regional Medicaid Services. 1 Unit = 1 Mile. Maximum allowable of 1,800 waiver miles per year. Yes (First Trip, No modifier) (Subsequent trips, same day, Modifier 76 required) POS 99
Attendant salary T2001 Non-emergency transportation, patient attendant/escort (salary). Spouse or parent of a minor child cannot be paid as attendants. Yes No POS 99