Summary & Overview
HCPCS A0160: Non-Emergency Transportation Per Mile by Case or Social Worker
HCPCS Level II code A0160 denotes non-emergency transportation billed on a per-mile basis when provided by a case worker or social worker. This code is used to capture mileage for community-based, non-emergency conveyance to medical appointments or social services and supports coordination of care and access for patients who lack other transportation options. Nationally, accurate use of this code affects access to services for vulnerable populations and contributes to care coordination metrics and cost-of-care reporting.
Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the code’s clinical intent, typical sites of service, common billing modifiers and procedural context, and comparative payer coverage considerations. The publication also summarizes benchmarks for utilization, documentation expectations, and policy updates that influence when and how mileage-based transportation is billed. Practical clinical context clarifies scenarios in which a case worker or social worker provides transport and when per-mile billing applies.
This summary is written for a national audience and focuses on billing definition, payer considerations, and operational implications for providers and administrators seeking clarity on appropriate claim reporting for non-emergency, per-mile transportation by social service staff.
Billing Code Overview
HCPCS Level II code A0160 represents non-emergency transportation billed per mile when provided by a case worker or social worker. This service covers transportation for patients who require non-emergency conveyance for medically related appointments or social service needs when the driver or provider is a case worker or social worker.
Service type: Non-emergency medical/social service transportation, per mile
Typical site of service: Community-based transportation to medical appointments or social service destinations (non-emergency, point-to-point travel)
Additional details: Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A social worker arranges non-emergency transportation for a homebound adult patient who needs a scheduled outpatient behavioral health follow-up visit at a community mental health clinic. The patient has mobility limitations and limited access to personal or public transportation. The case worker documents the need for transportation, the trip purpose, pickup and drop-off addresses, miles traveled, and any assistance required during the trip. The transportation provider bills per mile using A0160 for the case worker/social worker trip. Typical workflow: referral/authorization from the clinic social work team, scheduling with a transportation vendor, verification of pickup time and address, transport to the appointment, confirmation of drop-off and return (if applicable), and submission of mileage-based claim with supporting documentation of purpose and beneficiary identity.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier / default | Used when no special modifier applies to the transport claim. |
22 | Increased procedural services |