Home ►
Prior authorization ►
Prior authorization program for repetitive scheduled non-emergent ambulance transports
Last Modified: 4/19/2024
Location: FL, PR, USVI
Business: Part B
CMS began operating the repetitive scheduled non-emergent ambulance transports (RSNAT) prior authorization (PA) program in limited states in 2014 under the authority of the Social Security Act. In subsequent years, the Medicare Access and CHIP Reauthorization Act of 2015 required that the model expand to all states if such an expansion met certain criteria outlined in the Act. The model has met all nationwide criteria, and CMS has received final approval to expand the model nationwide. In April 2022 this program will be implemented for providers in First Coast’s jurisdiction:
Effective March 18, 2022, CMS will prior authorize certain repetitive scheduled non-emergent ambulance transports for dates of service on or after April 1, 2022, in Florida, Puerto Rico and the US Virgin Islands.
By submitting a completed coversheet and the required documentation, a supplier can receive provisional prior authorization for as many as 40 round trips (80 one-way transports) in a 60-day period.
A repetitive ambulance service is defined as a medically necessary ambulance transportation that is furnished three or more times during a 10-day period, or at least once per week for at least 3 weeks (round trips).
The model includes the following HCPCS codes:
• A0426 - Ambulance service, advanced life support, non-emergency transport, level 1 (ALS1)
• A0428 - Ambulance service, basic life support (BLS), non-emergency transport
HCPCS code A0425 is considered an associated service and will not receive prior authorization.
Note: Ambulance suppliers under review by a unified program integrity contractor (UPIC) are not eligible to submit prior authorization requests (PARs).
Prior authorization should ideally be requested prior to rendering transports. The PAR must include all documentation necessary to show that the service meets applicable Medicare coverage, coding, and payment rules.
Note: This form is available for submission through our secure internet portal SPOT. If you do not have a SPOT account,
learn how to register.
Prior authorization is voluntary, however if the ambulance provider elects to bypass prior authorization, First Coast will stop an applicable claim for prepayment review if submitted without a prior authorization request decision.
If the normal timeframe jeopardizes the life or health of the beneficiary, you can submit an expedited request. However, if medical documentation does not support an expedited process, the request will be subject to the normal timeframe.
• Use the prior authorization request repetitive non-emergent ambulance Medicare Part B fax/mail coversheet
• Request Type: Expedite
• If you selected "Expedite," please explain why the normal time frame jeopardizes life or health of the beneficiary. Medical documentation must also support the need for an expedited review.
• Complete all other required fields on the form.
First Coast will make reasonable efforts to communicate a decision within two business days of receipt an accepted expedited request.
MACs may now allow up to 240 one-way trips in a 180-day period per prior authorization request for beneficiaries with chronic conditions that are deemed not likely to change over time and meeting all Medicare requirements for repetitive non-emergent ambulance transport. The medical records must clearly indicate the condition is chronic. In addition, two previous prior authorizations requests must have established that the beneficiary’s medical condition has not changed or has deteriorated from previous requests before the MACs may allow an extended affirmation period.
• The decision to allow an extended affirmation period is at MAC discretion. Ambulance suppliers cannot request transports beyond the current maximum of 80 transports per 60-day period.
• Ambulance suppliers are responsible for always maintaining a valid physician certification statement (PCS).
• The MACs reserve the right to request the PCS at any time.
• Each individual time a patient is transported by ambulance, that transport must be reasonable and necessary regardless of whether a new prior authorization is required.
Reminder: UTNs are required on corresponding claims –
learn more
Question |
Answer |
WHO |
Ambulance service suppliers that bill Medicare Part B can receive provisional prior authorization in JN (Florida, Puerto Rico and U.S. Virgin Islands) |
WHAT |
Suppliers can receive prior authorization for up to 40 non-emergency scheduled round trips (HCPCS codes A0426, A0428) or 80 one-way transports in 60 days. For scheduled trips beyond the prior authorized number, a second prior authorization request is required. |
WHEN |
Effective March 18, 2022, CMS will prior authorize certain repetitive scheduled non-emergent ambulance transports for dates of service on or after April 1, 2022, in Florida, Puerto Rico and the USVI. |
WHERE |
Ambulance suppliers garaged in Florida, Puerto Rico and U.S. Virgin Islands. |
WHY |
The purpose of the prior authorization program is to reduce improper payments, while maintaining or improving quality of care. It is designed to ensure all relevant coverage, coding, and medical record(s) requirements are met before the service is rendered to the beneficiary and the claim is submitted for payment. |
HOW |
Submit the PAR. Attach the required medical records. Request decision notifications will be issued within 10 business days of receipt of submission. Resubmitted decision notifications will be issued within 10 business days of receipt. The notification will contain a 14-digit unique tracking number (UTN) that should be submitted in Item 23 of the CMS 1500 (02/12) claim form or the electronic equivalent. |
Additional education opportunities: View these videos related to ambulance services:
To meet coverage criteria, the patient's medical record must contain documentation that fully supports the medical necessity for services.
For more information on coverage and documentation requirements, refer to the following resources:
Prior authorization customer service phone number: 1-855-340-5975
Fax number: 1-855-815-3065
Mailing address:
First Coast Service Options, Inc.
JN Prior Authorization
PO Box 3033
Mechanicsburg, PA 17055-1804
Priority mailing address:
First Coast Service Options, Inc.
Attention: JN Prior Authorization
2020 Technology Parkway
Suite 100
Mechanicsburg, PA 17050
First Coast Service Options (First Coast) strives to ensure that the information available on our provider website is accurate, detailed, and current. Therefore, this is a dynamic site and its content changes daily. It is best to access the site to ensure you have the most current information rather than printing articles or forms that may become obsolete without notice.
