Montana Medicaid Transportation (FAQ)
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This FAQ explains Montana Medicaid transportation services (personal, specialized non-emergency, commercial, ambulance), prior authorization requirements, billing and reimbursement processes, and contact resources for members and providers.
No material clinical or coverage changes in this revision.
Transportation Coverage and Billing Criteria
Transportation coverage criteria
Coverage and billing criteria by transportation type
ALL of the following
- Covered: Yes (reimbursement, not billable).
Reimbursement is based on mileage; payment mailed after appointment verification; not billed on CMS-1500.
- Prior authorization: Required.
- Who may obtain authorization: No restriction — CHR driver, hospital clerk, individual, etc.
- Mileage rate: $0.33 per mile.
- Procedure/Diagnosis codes: Not applicable (no procedure or diagnosis code for personal transportation).
- How payment is issued: Hard-copy check mailed to designated person after MPQH verifies appointment was kept.
ALL of the following
- Covered: Yes (for members who are wheelchair-bound or require stretcher transport).
Must be provided by Medicaid-enrolled providers in specialized vehicles (mechanical lift).
- Prior authorization: Required; complete Travel Request Form for each client and obtain authorization from Mountain Pacific Quality Health (MPQH).
- Provider enrollment/NPI: Provider must be enrolled and include NPI on CMS-1500 claims to be paid.
- Billing form: Must bill Medicaid using CMS-1500 with prior authorization number.
- Payment rate: $13.09 per trip for trips 16 miles or less (flat trip rate).
- Diagnosis code guidance: Use the appropriate diagnosis for the member's condition; if unknown use Z02.9 for in-town medical trips or Z75.3 for out-of-town medical trips.
- How mileage is determined: MPQH uses a web-based system to determine loaded miles from actual pickup to drop-off; payment is to the closest provider.
Billing Codes, Mileage Thresholds, and Diagnosis Guidance
| Z02.9 | Use for in-town trips to medical appointments when current health condition is unknown |
| Z75.3 | Use for out-of-town medical appointments when current health condition is unknown |
Prior Authorization and Provider Requirements
Prior authorization required — Personal and Specialized Non‑Emergency Transportation
Prior authorization is required for Personal Transportation and Specialized Non-Emergency Transportation. To obtain prior authorization contact Mountain Pacific Quality Health (MPQH) at (800) 292-7114 or fax the Travel Request Form to (800) 291-7791.
Service Type Definitions
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