Non-Emergent Transportation Services (Routine Transportation Coverage Criteria)
Customize your policy alerts
Sign up for all astivahealth policy alerts
Know when astivahealth releases new policies or updates existing guidance.
Monitor payer policy activity
This policy governs coverage and operational rules for routine, non-emergency transportation (taxi or wheelchair van) for eligible Astiva Health members, affecting Medicare, Dual, and related lines of business.
No material clinical or coverage changes in this revision.
Coverage Criteria for Routine Non-Emergent Transportation
Routine Transportation Coverage Criteria
Covered when ALL of the following are met:
Ambulance transport is excluded from routine non-emergent transportation coverage. Routine services are provided using taxi or wheelchair van only and do not include ambulance transport.
Rides to non-medical destinations are excluded from coverage. Examples of excluded non-medical destinations include grocery stores, health clubs, and senior centers.
Transportation to non-medical destinations is not covered and is considered not medically necessary under this policy. Members should not expect coverage for travel to locations such as shopping, recreational, or social venues that are not qualifying medical service sites.
Operational Limits and Coding-related Limits
Provider / Member Scheduling and Denial Triggers
Pre-schedule via Member Services; Annual 52-trip limit
Member transportation must be pre-scheduled through Member Services at least 48 hours (not including weekends) before the appointment; members are limited to 52 one-way trips annually.
- Schedule via Member Services: 866-688-9021 or TTY 711.
- Annual limit: 52 one-way non-emergency transportation trips per member.
Operational requirement: vehicle type and provider
Operational note: transportation is provided via contracted taxi or wheelchair van for non-emergent qualifying medical services and does not include ambulance transport.
- Use contracted transportation providers only (taxi or wheelchair van).
- Ambulance transport is excluded.
Scheduling and cancellation requirements
Members must schedule transportation with Member Services; transportation arrangements must be made at least 48 hours (not including weekends) in advance for passenger and wheelchair service. Rides must be cancelled prior to driver dispatch to avoid being counted against the annual limit.
- Schedule at least 48 hours (not including weekends) in advance for passenger and wheelchair service.
- Call Member Services to pre-schedule: 866-688-9021 or TTY 711.
- Cancel rides before driver dispatch to prevent the trip from being counted and deducted from the annual limit.
Denial or deduction triggers
Trips that exceed established limits or that are not cancelled before driver dispatch may be denied or deducted from the member's annual allowance.
- Trips exceeding the annual limit of 52 one-way rides may not be covered.
- One-way trips over 25 miles are not permitted and may be denied.
- If a ride is not cancelled before the driver has been dispatched, the ride will count and will be deducted from the annual ride limit.
Definitions and Acronyms
Background
This policy covers routine, non-emergent transportation for eligible members when travel is to qualifying medical services and is provided by taxi or wheelchair van. It is intended to enable access to medically necessary appointments within defined operational limits, and does not include ambulance transport.
Operational requirements include advance scheduling through Member Services and adherence to the policy’s distance and annual trip limits; see the Coverage Criteria and Provider Actions sections for specific thresholds and scheduling instructions.
OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.