Medicaid Transportation Services (Chapter 18)
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Governs Alabama Medicaid transportation services (ambulance, air, NET/volunteer) including definitions, provider participation, prior authorization, payment, and operational requirements for transporting eligible recipients.
No material clinical or coverage changes in this revision.
Coverage rules and limitations
Ambulance and Air Transport Coverage Criteria
Coverage rules and limitations for ambulance and air transportation services:
Emergency ambulance services are covered for the following origins/destinations:
- Scene (address) of emergency to local hospital.
- Nursing home to local hospital.
- Local hospital to specialized hospital (e.g., transfer to tertiary center).
Covered Services and Eligibility
Coverage and eligibility
Reimbursement Mechanisms and NET Administration
Reimbursement and administration
Allowed Modes and Escort Rules
Modes of transport and escorts
Allowed modes (use least costly appropriate):
- Automobile (volunteer driver). Multiple passenger transportation is encouraged.
- Transportation provided by relatives or individuals living in the same household with the recipient.
- Transportation provided in the recipient's or relative's vehicle.
- Minibus services.
- Wheelchair van services; escorts allowed for wheelchair vans when prior approved by the Alabama Medicaid Agency.
- Commercial or city transit buses (in‑state or out‑of‑state).
- Airplane transportation (in‑state or out‑of‑state) when authorized.
- Train service (in‑state or out‑of‑state).
- Ambulance (emergency and certain nonemergency per scope rules).
Service Limits and Non-covered Services
Limitations and exclusions
Non‑covered services include (examples):
- When appropriate free transportation is available.
- Travel when the Medicaid recipient is not an occupant of the vehicle unless that is the most economical transportation available.
- Meals and lodging for volunteer drivers.
- Use of medical supplies (e.g., oxygen, IV fluids) during NET trips.
- Transportation for services not covered by Medicaid.
- Transportation provided after the death of a Medicaid recipient.
Provider and Driver Requirements / Exclusions
Provider and driver eligibility requirements
Claims, codes, and payment notes
Authorization, documentation, and provider obligations
Prior authorization required for nonemergency ambulance ≥100 miles (one-way)
Prior authorization is required for all nonemergency ambulance service rendered to eligible Alabama Medicaid recipients 100 miles or more one way where medical care is received. All requests for prior authorization by the attending physicians or their representatives must be directed to Medicaid's Fiscal Agent.
Air transport must be authorized and documented as medically necessary
Air transportation for adults and children requires authorization prior to payment and may be rendered only when basic and advanced life support land ambulance services are not appropriate; medical appropriateness must be documented (e.g., time, instability, inaccessibility or other obstacles make land transport a threat to life or health).
NET payments require prior authorization and are coordinated by NET
All payments for Non-Emergency Transportation (NET) services must have prior authorization by the Alabama Medicaid Agency except for services listed in Rule 560-X-18-.04(6) and services requiring urgent care; the NET Program assigns prior authorization numbers and coordinates transportation arrangements.
- Urgent care is defined as medical care required after normal business hours; reimbursement requests for urgent NET must be made the first business day after the transportation need.
- NET staff determine availability of free transportation, verify eligibility and appointment, determine least costly appropriate transportation, assign prior authorization numbers, and coordinate in-state and out-of-state commercial transportation.
Air transport authorization conditions and payment limits
Air transport requires authorization prior to payment; the patient must be taken to the nearest appropriate hospital with an available bed or specialized unit. If the patient is not taken to the nearest appropriate hospital, payment will be limited to the rate for distance to that hospital, and if land ambulance would have been more appropriate, payment for air transport will be based on the land transportation amount. Trips under 75 loaded air miles are generally not appropriate unless extreme, extenuating circumstances are documented.
- Patient must be transported to the nearest appropriate facility with available bed/specialized unit.
- If land transport would have been appropriate, air payment limited to land rate.
- Trips <75 loaded air miles require documentation of extreme extenuating circumstances to be considered appropriate.
Missing prior authorization results in non-coverage (denial risk)
Services for which prior approval is required but not obtained are non-covered and therefore subject to denial.
Key definitions used in this policy
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