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Provider Quick Tips #247: Nonemergency Ambulance Transportation 

Updated: June 21, 2021; Issued: May 8, 2020

COVID-19 is a communicable virus that is particularly dangerous to individuals with compromised immune systems and other chronic medical conditions as well as individuals 65 years of age and older. It can be transmitted through close personal contact. Transportation to and from medical appointments, when beneficiaries cannot secure their own transportation, is normally provided through the Medical Assistance Transportation Program (MATP). Due to COVID-19, MATP will use screening criteria for drivers and beneficiaries that may make transportation through that service unavailable or inappropriate for beneficiaries with compromised immune systems or who are otherwise at risk of contracting or communicating the virus. Because medical procedures and services that are elective are permitted under guidance issued on April 27, 2020, by the Secretary of Health, there are Medical Assistance (MA) beneficiaries who will continue to have a need for transportation to receive in-person health care services or urgent treatments. 

The Department of Human Services (DHS) is issuing this guidance to remind providers that nonemergency ambulance transportation may be used when medically necessary to transport MA beneficiaries receiving services in the Fee-for-Service (FFS) delivery system and HealthChoices members to medical appointments when transportation through MATP is not available or appropriate according to the COVID- 19 screening criteria. This guidance does not preclude other types of trips that are normally provided through nonemergency ambulance transportation. 

Nonemergency ambulance transportation to medically necessary services for FFS beneficiaries will be paid by submitting a claim using Procedure Code A0428 (Ambulance service, basic life support, nonemergency transport, (BLS)). 

Nonemergency ambulance transportation continues to be available in the Physical Health HealthChoices program. In order to provide nonemergency ambulance transportation to an individual enrolled in an MCO, a provider should contact the individual’s MCO for direction and billing instructions for this service. Please refer to the Frequently Asked Questions document related to COVID-19 for the provider services phone numbers for each MCO. The Office of Medical Assistance Program (OMAP) has instructed the Physical Health HealthChoices MCOs to pay for nonemergency ambulance transportation wherever appropriate in a manner that is consistent with the HealthChoices Agreements. For specific questions related to a HealthChoices Managed Care Organization’s (MCO) payment rates or billing processes for nonemergency ambulance transportation, contact the MCO’s provider services hotline directly. 

OMAP has issued guidance related to the use of telemedicine as well to encourage provision of services through telemedicine to minimize the need for in-person treatment and transportation. 

Guidance regarding the use of COVID-19 CR modifiers and DR condition codes was issued on April 16, 2020. These CR modifiers and DR condition codes should be used as appropriate on claims for nonemergency ambulance transportation services provided due to the COVID-19 virus to FFS beneficiaries and HealthChoices members. 

This guidance will remain in effect for the duration of the Federal public health emergency related to the COVID-19 virus. DHS may revise this guidance as appropriate. 

Additional information about COVID-19 is available on the CDC website and through CMS

Information on MA Program coverage for testing for and treatment of COVID-19, including an FAQ document, can be found on the Department of Human Services website here

The Pennsylvania Department of Health provides regular updates on its dedicated webpage for COVID-19. Click here for the most up-to-date information regarding COVID-19.