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Harvard Pilgrim Health CareMedicare Advantage · Prior Auth · Prior Authorization · Emergency Medicine, General PracticeMedium impact

Authorization reminder: non-emergent medical transportation

Act
immediately
Effective date
Not stated in the notice
Identified
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.

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What to do

immediately · 3 steps
01Billing 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.
02Review Point32Health's Non-Emergent Ambulance Transportation Medical Necessity Guidelines for specific criteria and modifier requirements.
03Claims submitted without prior authorization will be denied.

Codes mentioned

A0426A0428A0430A0435

Original notice

Authorization reminder: non-emergent medical transportation
point32health.org · Always check the source before changing claims.
View original ↗

Related policy hubs

Harvard Pilgrim Health Care policiesEmergency MedicineGeneral PracticeCode A0426Code A0428Code A0430Code A0435

Summaries are AI-assisted. Always confirm against the original payer notice.

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