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HumanaMedicaid · Prior Auth · Medicaid · KYHigh impact

Nonemergency Ambulance Transportation - MEDICAID - KENTUCKY (New)

Effective date
Jun 29, 2026
Identified
Jun 26, 2026

Summary

Humana Kentucky Medicaid has issued a new policy (effective 06/29/2026) establishing coverage criteria and prior authorization requirements for nonemergency ambulance transportation. Billing teams must now require prior authorization for nonemergency ground and air ambulance services (HCPCS codes A0428, A0430, A0431) and verify five specific medical necessity criteria before claim submission. This is a brand-new policy with no previous guidance superseded.

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What to do

Action · 6 steps
01Before 06/29/2026: Billing team must implement prior authorization requirement in billing system for HCPCS codes A0428, A0430, and A0431 for Humana Healthy Horizons Kentucky Medicaid members.
02Create internal workflow checklist requiring verification of ALL five coverage criteria before claim submission: (1) patient confined to stretcher before/after transport, (2) medical condition contraindicates other transportation methods, (3) transport to/from Medicaid-covered service (excluding pharmacy), (4) service is least expensive option meeting patient needs, and (5) if out-of-service-area, physician referral exists AND services unavailable in-network.
03Update prior auth request templates to include these criteria.
04Train billing staff and providers that claims submitted without prior authorization or meeting these criteria will be denied.
05For members under 21, flag requests for EPSDT medical necessity review.
06Communicate to providers and ambulance service partners that nonemergency ambulance claims will not be processed without prior authorization on or after the effective date.

Codes mentioned

A0428A0430A0431

Original notice

Nonemergency Ambulance Transportation - MEDICAID - KENTUCKY (New)
mcp.humana.com · Always check the source before changing claims.
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Related policy hubs

Humana policiesKY policy changesCode A0428Code A0430Code A0431

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