CurrentBlue Cross Blue Shield - North DakotaPolicy N/A

Non-Medical Transportation Services

Policy governing provision, eligibility, limits, documentation, provider qualifications, billing, and covered/non-covered circumstances for non-medical transportation for members when no other free transportation is available.

Policy Summary

PayerBlue Cross Blue Shield - North Dakota

PolicyNon-Medical Transportation Services (coverage criteria)

Policy CodePolicy N/A

Change TypeNo material change

Effective DateN/A

Next Review DateN/A

Key ActionExplore and document all informal and community transportation options before requesting non-medical transportation; care coordinator should assist to ensure service is short-term.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

8 hrs/daydaily maximum

15-min (T2001)billing unit

All ageseligible members

Monthly updatedocumentation

Coverage Criteria for Non‑Medical Transportation

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Eligibility and purpose: Member is included (members of all ages) and transportation is needed to achieve a goal on the member's plan of care; no other reasonable free transportation (neighbors, family, friends, or community agencies) is available.

See examples of permitted destinations in Covered Services (e.g., job interview, 1915() services, education, grocery store, obtaining a bus pass, wellness or recovery meetings).

Member presence and service intent: Member must be present for the service; transportation is intended to complement and not replace Non‑Emergency Medical Transportation (NEMT) or other transportation supports.

Transportation to medical appointments is covered under NEMT, not this policy.

Prior use of alternatives: All other transportation options (informal supports, community services, public transportation) have been explored and utilized prior to requesting non-medical transportation; the care coordinator is assisting to make this a short-term service.

Providers and care coordinators must document exploration of alternatives before requesting non-medical transportation.

Non-medical transportation is subject to specific limitations. It does not cover time spent waiting for a member, and it does not cover the cost of staff travel to or from the member’s home or location. Additionally, this service cannot be billed concurrently with another 1915() service (for example, a provider may not transport a member while also providing peer support).

Billing and Coding

Covered HCPCS CodesHCPCSCovered

T2001

Non-Medical Transportation (per 15 minutes)

Minimum billable time — Single 15‑minute unit rules

Minimum billable incrementA single 15-minute unit may be billed for services greater than or equal to 8 minutes.

Combining time for billingServices with the same Place of Service (POS) and for the same member can be combined and billed when adding up to at least 8 minutes.

Example unit thresholds1 unit = >8 to 22 minutes; 2 units = 23 to 37 minutes; 3 units = 38 to 52 minutes; pattern continues for longer durations.

Daily maximum units

Daily maximum service timeServices are limited to a daily maximum of 8 hours (32 units).

Unit conversion8 hours per day corresponds to 32 of the 15-minute billing units (T2001).

Applies toLimit applies to non-medical transportation services per day as stated in policy limits.

Provider Responsibilities and Operational Requirements

Prior Authorization

Exploration of alternative transportation before requesting service

All other transportation options must be explored and utilized before requesting non-medical transportation. Providers and care coordinators must first attempt to arrange free or low-cost options such as family, friends, neighbors, community agencies, public transit, bus passes, or informal/community supports. Non-medical transportation is intended to complement—not replace—existing supports and Medicaid Non-Emergency Medical Transportation (NEMT).

Member must be present for the service
Informal supports and community resources must be used wherever possible before requesting non-medical transportation
Public transportation or community transit options must be considered prior to approval

Denial Risk

Triggers for denial or non-coverage

Requests for non-medical transportation may be denied or considered non-covered when other free transportation sources are available or when the transportation is for an excluded purpose. Examples of non-coverage or denial triggers include: transportation to medical appointments (covered under NEMT), time spent waiting for a member, staff commuting to/from a client location, or situations where the service would duplicate another 1915() service (a provider cannot transport a member and bill concurrently for another 1915() service).

Transportation to a medical appointment (use NEMT)
Time spent waiting for a member is not covered
Staff transportation to or from the client's home or location is not covered
Transportation billed concurrently with another 1915() service is not allowed

Documentation Required

Required documentation and location

Providers must document use (or attempted use) of informal supports and community resources and provide a written monthly update to the member's care coordinator. Documentation must affirm that friends, family, neighbors, or community agencies were unavailable or unable to provide transportation at no cost. Beginning January 6, 2025, service documentation must be entered in Therap using the Non-Medical Transportation Case Note and must follow the Documentation Guidelines in the Provider Requirements policy for Medicaid.

Monthly written update to care coordinator required
Document lack of available informal supports or community resources
Enter service documentation in Therap using the Non-Medical Transportation Case Note beginning 2025-01-06
Follow Documentation Guidelines in Provider Requirements policy for Medicaid

Background

Non-medical transportation assists members in accessing community services, activities, and resources identified in the member’s person-centered plan of care when no other reasonable free transportation is available. It is intended to support achievement of plan goals (for example, transportation to a job interview, 1915() services, education or meetings specified in the plan of care, grocery shopping, or obtaining a driver’s license) and is offered in addition to, but does not replace, medical transportation services such as NEMT.

Definitions

Non‑medical transportation — definition and scope

DefinitionTransportation provided to support achievement of goals in a member's person‑centered plan of care (e.g., job interviews, 1915() services, education, grocery stores, obtaining a driver's license, acquiring transportation), provided when no other free transportation source is available.

Typical permitted destinationsExamples include job interviews, 1915() services, college fair, AA or similar meetings specified in the plan of care, grocery store or food bank, GED preparatory class, wellness seminar.

Relation to medical transportationNon‑medical transportation complements but does not replace Non‑Emergency Medical Transportation (NEMT); transportation to medical appointments is covered under NEMT, not this policy.

Use of informal supportsWherever possible, neighbors, family, friends, or community agencies who provide transportation without charge must be used before requesting non‑medical transportation.