We’ve developed integrated Point32Health Medical Necessity Guidelines for Non-Emergency Medical Transportation (Air and Ground), which will be effective for dates of service beginning June 1, 2024 and replace the following existing Harvard Pilgrim and Tufts Health Plan MNGs: Non-Emergency Medical Transportation (Air), Non-Emergency Medical Transportation (Ground), and Medical Transportation.
The MNG will be utilized for the review of all non-emergency medical transportation for Point32Health members.
As of the June 1 effective date, for Harvard Pilgrim members, we are expanding the list of origin and destination modifier combinations not requiring prior authorization to include the following:
- DH (Diagnostic or therapeutic site, other than P or H to Hospital)
- EH (Custodial facility to Hospital)
- GH (Hospital-based dialysis facility to Hospital)
- HD (Hospital to Diagnostic or therapeutic site, other than P or H)
- HG (Hospital to Hospital-based dialysis facility)
- HH (Hospital to Hospital)
- HJ (Hospital to Non-hospital dialysis facility)
- JH (Non-hospital dialysis facility to Hospital)
- HN (Hospital to Skilled nursing facility)
- NR (Skilled nursing facility to Residence)
- PH (Physician’s office to Hospital)
- RH (Residence to Hospital)
- RN (Residence to Skilled nursing facility)
For Tufts Health Plan, HCPCS codes S9960 (Ambulance service, conventional air services, nonemergency transport, one way [fixed wing]) and S9961 (Ambulance service, conventional air service, nonemergency transport, one way [rotary wing]) will no longer be covered and will deny when billed.
For complete information, please refer to the Medical Necessity Guidelines for Non-Emergency Medical Transportation (Air and Ground).
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