Ambulance PA

The Prior Authorization Demonstration for South Carolina began on December 1, 2014, and expanded to North Carolina, Virginia and West Virginia on January 1, 2016. This applied to ambulance suppliers that were not institutionally (hospital) based that provided Part B Medicare covered ambulance services and were enrolled as an independent ambulance supplier. Prior authorization is a process through which a request for affirmation of coverage is submitted for review before a service is rendered to a beneficiary and before a claim is submitted for payment. Prior authorization helps ensure that applicable coverage, payment and coding rules are met before services are rendered.

General Facts About the Program


Ambulance service providers that bill Medicare Part B and render Repetitive Scheduled Non-Emergent Ambulance Transportation can receive provisional prior authorization.


Providers can receive prior authorization for up to 40 non-emergency scheduled round trips (HCPCS codes A0426, A0428) in 60 days. For scheduled trips beyond the prior authorized number, a second prior authorization request is required.

  • Phase I  — South Carolina applies to dates of service on or after December 1, 2014
  • Phase II — North Carolina, Virginia and West Virginia applies to dates of service on or after January 1, 2016
  • CMS announced that it will expand the Repetitive, Scheduled Non-Emergent Ambulance Transport (RSNAT) Prior Authorization Model nationwide, as the model has met all expansion criteria under section 1834(l)16 of the Social Security Act (the Act) (as added by section 515(b) of the Medicare Access and CHIP Reauthorization Act of 2015 (Pub. L. 114-10) (MACRA)

Providers with ambulances garaged in South Carolina, North Carolina, Virginia and West Virginia should submit prior authorization requests for transports in those states to Palmetto GBA.


The process tests Medicare prior authorization procedures, which are designed to improve quality of service and reduce costs.


Submit the prior authorization request. Attach the required documentation. Decision notifications will be issued within 10 business days of receipt of submission.

  • Resubmittal decision notifications will be issued within 20 business days of receipt
  • The notification will contain a 14-digit unique tracking number (UTN) that should be submitted in Item 23 on applicable paper claims or the electronic equivalent field for electronic claims

Ambulance PA Articles

Overview of the Repetitive Scheduled Non-emergent Ambulance Prior Authorization ModelPrior Authorization Requests for Repetitive Scheduled Non-emergent Transports DocumentationDocumentation Tips for Ambulance Providers: Paint the PictureRelease of Beneficiary Information to Ambulance Providers of Repetitive Scheduled Non-Emergent TransportsPhysician Compliance: Ambulance Prior Authorization DocumentationBeneficiary Non-Affirmation Letter for Ambulance Prior AuthorizationAmbulance Prior Authorization eServices Form (HCPCS A0427, A0429) ModuleAmbulance Prior Authorization Request FormNon-Affirmed Code Crosswalk: Prior Authorization RequestAmbulance Prior Authorization RemindersFrequently Asked Questions: Prior Authorization (PA) Repetitive Scheduled Non-Emergent Ambulance TransportsAmbulance Suppliers of Repetitive Scheduled Non-Emergent TransportsUpdate: Prior Authorization of Repetitive, Scheduled Non-Emergent Ambulance TransportJurisdiction M Part B Prior Authorization Extended Affirmation Teleconference Questions and Answers: August 14, 2019Prior Authorization of Repetitive Scheduled Non-Emergent Ambulance TransportsAdministrative Relief in Response to the 2019-Novel Coronavirus (COVID-19) Pandemic: Pausing Repetitive, Scheduled Non-Emergent Ambulance Transport (RSNAT) Prior Authorization ModelPhysician/Practitioner LetterEnhanced eServices Ambulance Prior Authorization FormAmbulance Prior Authorization Documentation Decision ToolWe're All In This Together Flyer - Wound Care Facilities (WCF)We're All In This Together Flyer - Dialysis FacilitiesAmbulance Fee Schedule and Medicare Transports CMS Booklet