MedicaidPrior AuthHigh impact
Coming Soon: Frequency, Mileage and Documentation Updates for NEMT and NMT
Medi-Cal·CA·Provider Bulletin
Effective date
Nov 1, 2026
We identified it
Oct 27, 2026
Summary
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.
Action Required
By November 1, 2026: (1) Billing team must update billing software to enforce frequency limits for HCPCS code A0120 (maximum two one-way trips per day or five round trips per week per member per provider) and mileage limits for code A0390 (maximum 50 miles per trip); (2) Prior authorization staff must implement new TAR approval logic capping authorization periods at 6 months for NEMT, or 12 months for chronic conditions, with requirement for new TAR and written prescription with ICD-10-CM diagnosis code to demonstrate continued need; (3) Billing team must verify that all NMT claims for codes A0120 and A0390 include documentation stating the member required NMT for Medi-Cal-covered medical, mental health, substance use, dental, or other services—missing documentation may trigger claims examiner review; (4) Providers and authorization staff should review updated provider manual requirements for NEMT written prescriptions and NMT member attestation verification when published. Claims exceeding frequency or mileage limits will be subject to claims examiner review, potentially resulting in denial or recoupment.