Back to Insights and Updates for ProvidersApril 2024

MNG update: Non-Emergency Medical Transportation

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We’ve developed integrated Point32Health Medical Necessity Guidelines for Non-Emergency Medical Transportation (Air and Ground), which will be effective for dates of service beginning June 1, 2024 and replace the following existing Harvard Pilgrim and Tufts Health Plan MNGs: Non-Emergency Medical Transportation (Air), Non-Emergency Medical Transportation (Ground), and Medical Transportation.

The MNG will be utilized for the review of all non-emergency medical transportation for Point32Health members.

As of the June 1 effective date, for Harvard Pilgrim members, we are expanding the list of origin and destination modifier combinations not requiring prior authorization to include the following:

  • DH (Diagnostic or therapeutic site, other than P or H to Hospital)
  • EH (Custodial facility to Hospital)
  • GH (Hospital-based dialysis facility to Hospital)
  • HD (Hospital to Diagnostic or therapeutic site, other than P or H)
  • HG (Hospital to Hospital-based dialysis facility)
  • HH (Hospital to Hospital)
  • HJ (Hospital to Non-hospital dialysis facility)
  • JH (Non-hospital dialysis facility to Hospital)
  • HN (Hospital to Skilled nursing facility)
  • NR (Skilled nursing facility to Residence)
  • PH (Physician’s office to Hospital)
  • RH (Residence to Hospital)
  • RN (Residence to Skilled nursing facility)

For Tufts Health Plan, HCPCS codes S9960 (Ambulance service, conventional air services, nonemergency transport, one way [fixed wing]) and S9961 (Ambulance service, conventional air service, nonemergency transport, one way [rotary wing]) will no longer be covered and will deny when billed.

For complete information, please refer to the Medical Necessity Guidelines for Non-Emergency Medical Transportation (Air and Ground).

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