Point32Health wants to remind our provider network that — as we announced in the November 2024 issue of Insights and Updates for Providers — prior authorization is required for the following codes associated with non-emergent medical transportation for our Tufts Medicare Preferred members: 

  • A0426
  • A0428
  • A0430
  • A0435

Our Non-Emergent Ambulance Transportation for Tufts Medicare Preferred (HMO and PPO) Medical Necessity Guidelines detail the prior authorization requirements for non-emergent medical transportation, including criteria, coverage limitations, and modifier combinations for various required transfer types (e.g., hospital to non-hospital-based dialysis facility, hospital to skilled nursing facility). 

As a reminder, the prior authorization requirement does not apply to emergent medical transportation using an ambulance, or to non-emergent medical transportation using another other type of vehicle, such as a wheelchair van or chair car. The intention of the policy is to encourage the use of the least intensive means of transportation whenever possible, which helps manage costs for members and helps ensure that prompt ambulance transportation is accessible for those who need it most.