Medi-Cal NEMT billing codes and rates: wheelchair van, litter van, and mileage

What Medi-Cal pays per trip

Each fee-for-service wheelchair van or litter van trip earns a fixed response amount for the one-way run and a per-mile amount for the distance the rider is on board. The schedule lists maximum allowances. DHCS reimburses the lower of your usual public charge and that maximum, so a provider whose public prices sit below the schedule is paid its own lower price. The usual and customary charge page explains why that matters when you set prices.

These rates apply to trips DHCS pays directly. Managed care members’ rides are a separate channel: the plan or its broker books them and pays the rate in your contract. The California state guide covers which broker serves which plan.

Medi-Cal calls a stretcher van a litter van, but the code on the claim is still T2005. The wheelchair and litter van page of the rate section was last updated in September 2023, and the non-medical transportation page in August 2020.

Rates when more than one rider shares the trip

When several riders load at one pickup point and travel to one destination, each rider’s base amount drops. You add a modifier to the base code on each rider’s claim.

Only the first rider’s claim carries mileage. The other riders’ claims carry the response code and any other service allowed for that rider, but no mileage. Each claim needs an attachment naming the other riders and their Medi-Cal ID numbers, and each TAR’s medical justification must list every rider and the control numbers of their TARs. The multiple-rider rates do not apply when riders have different pickup points or destinations.

Mileage, night calls, and waiting time

Each of these add-ons has its own documentation rule, and the claim has to show it.

• Mileage. Van mileage goes on A0380. A0425 is reserved for ambulance miles. Enter the miles from the pickup point to the destination as units, adding the return miles when a round trip is on one line, and list both full addresses, city and ZIP code included, in Box 19. Only loaded miles count.
• Night calls. A night call runs from the moment the unit is alerted until it arrives at the destination with the rider on board. If any part of that window falls between 7 p.m. and 7 a.m., the UJ modifier applies. Record the start and stop times in the TAR’s medical justification and again in Box 19.
• Night round trips. Bill both legs on one line with two units only if both legs happened at night. If only one leg was at night, use two lines and put UJ on one of them.
• Waiting time. Medi-Cal pays nothing for the first 15 minutes. Past that, each half hour is one T2007 unit, capped at three units. Waiting counts only while the crew is waiting to load the rider, and the clock times the wait began and ended belong in Box 19 or on an attached page.

The manual’s June 2023 update lets GPS tracking or digital mapping software replace odometer readings at each origin and destination. Mileage and a dry run cannot both be paid for the same rider and provider on the same day unless your records show the miles were for a real transport at a different time.

Authorization before the trip: the TAR and the prescription

Fee-for-service NEMT requires a Treatment Authorization Request (TAR), approved by the TAR Processing Center, for every trip except the one covered in the next section. DHCS approves only the lowest-cost type of transport that is adequate for the rider’s medical needs (22 CCR 51323(b)). A legible prescription, or a physician-signed order sheet for residents of an institution, goes with the TAR. It must state:

1. The purpose of the trip.
2. How often the rider needs to go, or the exact dates of transport.
3. The medical or physical condition that rules out ordinary public or private transportation.

For ongoing trips, the prescription must also describe the chronic nature of the condition and include a treatment plan. A diagnosis alone, such as “stroke,” is not enough. Doctors, dentists, and podiatrists can authorize NEMT. So can nurse practitioners, physician assistants, certified nurse midwives, therapists (physical, occupational, and speech), and providers of mental health or substance use disorder services.

A TAR line can carry up to four modifiers, and the claim’s modifiers have to be identical to the TAR’s or the claim will not pay. Modifier 99 is not allowed on NEMT codes. A claim that mixes emergency and non-emergency codes is denied, so keep them apart. The prior authorization entry covers how authorization works in other programs.

The one trip that needs no TAR

Moving an inpatient out of an acute hospital into a nursing facility at level A or B needs no TAR, prescription, or clinician signature. Bill the trip with modifiers HN and QN on A0130 or T2005, plus A0380 for mileage and T2001 if an attendant went along. The rates are the same as a regular trip. Medi-Cal does not pay waiting time or night calls on these transfers.

If you respond to one of these transfers and the rider is not moved, a dry run is still billable, using HN followed by QN on the base code, again without a TAR. On other trips, a dry run is billed by adding DS and then QN to the base code, and the manual has a separate UJ rule for dry runs at night.

Round trips and repeat trips on one day

Medi-Cal gives three ways to bill a round trip: one line with two units and one charge, two lines with one unit and a charge each, or two separate claims. Whichever you use, Box 19 must show the time of day and the destinations.

When the same rider takes more than one trip on the same date, list each trip’s time and destination in Box 19. You may also add modifier 76 to the repeated codes. Without that detail, the later trips can be denied as duplicates. Riders transported from a hospital while they remain inpatients take place of service code 21, with the hospital’s address and NPI in Boxes 32 and 32A.

Plan and broker trips pay differently

A trip for a managed care member follows the plan’s rules and the rate in your agreement with its broker. The fee-for-service schedule does not set that price.

• The PCS comes first. Health Net’s Medi-Cal manual, quoting the state’s plan contract, says plans must require an approved Physician Certification Statement (PCS) before they grant prior authorization for NEMT. Plans authorize recurring trips for up to 12 months and set up a standing order for them, and they cannot change the mode once the provider has prescribed it.
• Forms expire. A July 31, 2026 Health Net update for Fresno, Kings, and Madera counties says a PCS is needed for wheelchair van, litter van, ambulance, and air trips, authorizations last up to 12 months, and a new form is needed when they run out.
• Brokers pay the trip. Health Net uses Modivcare for most of its Medi-Cal members’ NEMT and non-medical rides. The California state guide lists the broker for each plan.

Treat the fee-for-service schedule as a reference point when a broker makes you an offer, not as the rate you will receive.

Filing limits and late claims

An original claim has to arrive within six months following the month of the trip. A trip on April 15 must arrive before October 31. If no approved delay reason applies, late claims are cut:

The reductions come from Welfare and Institutions Code section 14115. For a claim that spans several dates, Medi-Cal uses the “through” date to measure timeliness. The timely filing limit entry compares deadlines across programs.

Where the rates come from

The two most-used rates are written into California’s Medicaid state plan. State Plan Amendment 22-0039, approved by CMS on December 16, 2022 and effective July 1, 2022, set the wheelchair van base at $20.30 and wheelchair and litter van mileage at $1.50. The same amendment removed NEMT from the provider payment reductions in the state plan and adjusted base rates to keep payment at the level providers had been receiving. For January through June 2022, the state plan listed fixed supplemental amounts paid on top of base rates, including $4.41 for A0130 and $0.33 for A0380.

Since then the changes have been small. The September 2023 update changed the multiple-rider lines, and a March 2024 update changed the mileage line in the no-TAR hospital transfer table. The non-medical transportation page has not been updated since August 2020.

A worked example

Take an example: a daytime wheelchair van trip of 9 loaded miles, with a 45-minute wait before the rider is ready to load, billed at or above the maximum allowances.

The same trip at 8 p.m. with no wait pays $26.43 plus $13.50, or $39.93. For codes outside California, the NEMT billing codes guide lists what each one means, and how much Medicaid pays for NEMT compares Medi-Cal with other states.

Keeping the trip record in HealthRide

Almost every Medi-Cal rule above comes back to the details of a single leg: the addresses, the clock times, and the loaded miles. HealthRide’s driver app records GPS-recorded miles and timestamps for every leg, with signatures captured on screen. You can export the trip log as a CSV file or a PDF, so the detail is ready when a plan, a broker, or an auditor asks for it.