HCPCS A0120 is officially defined as "Non-emergency transportation: mini-bus, mountain area transports, or other transportation systems." HCPCS A0120 is referenced in 8 tracked payer policy changes from Sentara Health Plans, Medi-Cal, and 4 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for HCPCS A0120 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.
Starting January 1, 2027, Sentara Health Plans will require prior authorization for a long list of codes on Virginia commercial plans, including self-funded (ASO) plans, and for code 88380 on commercial, Medicaid and Medicare products, plus code 22860 on Medicare products. Sentara will also stop covering a separate list of codes on Virginia commercial and self-funded plans.
Effective November 1, 2026, Medi-Cal will update NEMT and NMT policies, including: NEMT TAR authorization periods capped at 6 months (or 12 months for chronic conditions) requiring new written prescriptions with ICD-10-CM diagnosis codes; NMT frequency limits for code A0120 (two one-way trips per day or five round trips per week) and mileage limits for code A0390 (50 miles maximum per trip); and enhanced documentation requirements for NMT claims. Billing teams must implement these limits, update prior authorization workflows, and ensure compliant claim submissions starting November 1, 2026.
South Dakota Medicaid is implementing comprehensive reimbursement rate increases effective July 1, 2026, including hospital methodology changes (MS-DRG to APR-DRG), FQHC alternative payment methodology, Care Connect tier rate adjustments, and 1.4% inflationary increases across professional services capped at 100% of Medicare. Billing teams must update fee schedules, verify rate changes for specific procedure codes, and align claims submission to new reimbursement methodologies.
Sentara Health Plans relaxed prior authorization requirements for 499 codes for commercial products offered in Virginia, covering categories such as medical and surgical supplies, cardiovascular procedures, proprietary laboratory analyses and outpatient PPS codes. Effective February 1, 2026, commercial prior authorization is required for a further set of codes, several psychological testing codes now require authorization only after the listed hour limits, and several commercial codes, including 99070, A9286, G0330 and S9152, are not covered. Self-funded commercial products had separate prior authorization and not-covered code lists effective February 1, 2026, and Medicaid changes took effect October 1, 2025 and December 1, 2025.
Health First Colorado reduces fee-for-service provider rates by 2.0% for dates of service on or after July 1, 2026, with exemptions for pharmacy, RHCs, FQHCs, Pediatric Behavioral Therapy, select NICU and maternity services, and family planning. Spravato (J0013, G2082, G2083) and Qivigy (J1577) are added to the physician-administered drugs that require prior authorization effective July 1, 2026. Pediatric Behavioral Therapy claims for CPT 97151 are limited to one unit per 365 days, and the ordering or referring practitioner NPI is required starting July 1, 2026. Neurological and psychological testing codes 96130, 96131, 96136 and 96137 require the SC modifier on fee-for-service claims, and vaccine counseling visits are billed with 90482, 90483 or 90484. This is from a June 2026 bulletin, so check current applicability before acting.
Blue Cross NC updated 34 medical policies with reference updates, code removals, and minor coverage criteria changes. Multiple billing codes were removed from various policies including ambulance services, clinical trials, infusion therapy, and skilled nursing services, requiring updates to billing systems.
South Dakota Medicaid implemented a 1.25% rate increase for most services effective July 1, 2025, with targeted increases for specific transportation and physician codes. Additionally, care management referrals are no longer required for outpatient mental health services as of June 1, 2025.
Air or water ambulance services to the nearest facility capable of providing appropriate treatment are medically necessary with documentation of ANY of the following: the emergency, accident or acute illness occurs in an area inaccessible by ground vehicles, or transport cannot be safely provided by ground ambulance due to great distances, prolonged transport time or other obstacles that would be harmful to the individual's medical condition. Ground ambulance services are medically necessary with documentation of ANY of the following: the individual's medical condition requires transport from the site of an emergency, accident or acute illness to the nearest facility capable of providing appropriate treatment, or interfacility transport for admission is needed when the transferring facility is unable to provide the level of service required. Transport provided primarily for the convenience of the individual, family or physician, transport to a physician's office, physical therapy, diagnostic or therapeutic services, home or other non-emergent outpatient services, and transport that would be otherwise appropriate in a stretcher van or wheelchair van are a benefit plan exclusion and not eligible for coverage.
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