MedicaidPrior AuthHigh impact
Nonemergency Ambulance Transportation - MEDICAID - KENTUCKY (New)
Humana·KY·Medicaid
Effective date
Jun 29, 2026
We identified it
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 This is a brand-new policy with no previous guidance superseded.
Action Required
Before 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. Create 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. Update prior auth request templates to include these criteria. Train billing staff and providers that claims submitted without prior authorization or meeting these criteria will be denied. For members under 21, flag requests for EPSDT medical necessity review. Communicate to providers and ambulance service partners that nonemergency ambulance claims will not be processed without prior authorization on or after the effective date.