Medicare AdvantagePrior AuthMedium impact
Authorization reminder: non-emergent medical transportation
Harvard Pilgrim Health Care·Emergency Medicine, General Practice·Prior Authorization
We identified it
Jun 20, 2026
Summary
Point32Health now requires prior authorization for specific non-emergent ambulance transportation codes (A0426, A0428, A0430, A0435) for Tufts Medicare Preferred members. Emergency ambulance transportation and non-ambulance medical transport (wheelchair vans, chair cars) are exempt from this requirement.
Action Required
Immediately: Billing team must update system to require prior authorization for codes A0426, A0428, A0430, and A0435 when billing for non-emergent ambulance transportation for Tufts Medicare Preferred (HMO and PPO) members. Review Point32Health's Non-Emergent Ambulance Transportation Medical Necessity Guidelines for specific criteria and modifier requirements. Claims submitted without prior authorization will be denied.