Medical Transportation Management - Minnesota Nonemergency Transportation (MTM-MNET), SmartLink and Local County or Tribal Agency Nonemergency Medical Transportation (NEMT) Services Claim, Service and Rate Information

Revised: May 22, 2024

Overview

County and tribal agency requests for Minnesota Health Care Programs (MHCP) reimbursement for nonemergency medical transportation (NEMT) service and ancillary services must be billed electronically through MN–ITS interactive or batch.

NEMT services providers cannot bill MHCP directly for Mode 3 – Unassisted transport (curb-to-curb) and Mode 4 – Assisted transport (door-to-door and door-through-door) services; and must contract with one of the following organizations for billing and reimbursement.

MTM-MNET, SmartLink and Local County or Tribal Agency Administered NEMT Transports
MTM-MNET, SmartLink or the local county or tribal agency determines the appropriate level of NEMT services for the member.

MTM-MNET, SmartLink or the local county or tribal agency coordinates or provides the NEMT transport; reimburses the individual or the transport provider; and bills the Minnesota Department of Human Services (DHS) for reimbursement of the service costs.

Exception: The Mode 4 = Assisted Transport level-of-service (LOS) assessments for establishing the appropriate level of transport are completed by the state contracted medical review agent. The member would contact the medical review agent and the local agency then coordinates or provides transport; reimburses the individual or transport provider; and bills MHCP or DHS for reimbursement of the service costs.

MTM-MNET, SmartLink or the local county or tribal agency-administered NEMT and the ancillary service claim submissions require several fields to be completed with correct and accurate information for the claim to be processed and paid. This section has general information for basic claim submission. Additional requirements may be necessary for access transportation and the related ancillary services claims to be billed and reimbursed correctly.

Claim Information

Basic claim information includes the following details:

Claim submission requires each service provided (each code) to be billed on a separate service line. Proper claim submission requires entry of the following information:

Submit claims for the appropriate transportation base and mileage rates for transport of an MHCP member with the service code and modifiers combinations listed on the table.

MTM-MNET, SmartLink and Local County or Tribal Agency-Administered Transportation Personal Mileage Codes, Modifiers and Payment Rates

Personal mileage codes and payment rates

Multiple unassisted and assisted transports on the same date of service
Billing for the base (pick-up) service code is limited to two units per service line per date of service (DOS). If the person is provided more than two transports on the same DOS, separate the base charges into two units per service line billed and include the “repeat service” modifier on the additional base service lines.

Bill the corresponding mileage on multiple service lines consistent with the base service lines billed.

Modifiers Required

For “Mode 4 – Assisted Transport” base (T2003) and mileage (S0215) an origination (pick-up) and destination (drop-off) identifier modifier combination is required. The modifier is determined by combining two individual location identifiers. The first indicator is the origination identifier, and the second identifier is for the destination. Indicators for the modifier are created from the identifiers used for Medicare ambulance billing. The indicators include the following:

D = Diagnostic or therapeutic site other than P = Physician or H = Hospital when these are used as origin codes
E = Residential, domiciliary, custodial facility (other than 1819 facility)
G = Hospital-based end stage renal disease (ESRD) facility
H = Hospital
I = Site of transfer (for example, airport or helicopter pad) between modes of ambulance transport
J = Freestanding ESRD facility
N = Skilled nursing facility
P = Physician’s office
R = Residence
S = Scene of accident or acute event
X = Intermediate stop at physician’s office on way to hospital (destination code only)

Personal and Volunteer Driver Mileage

Personal mileage codes and payment rates for personal and volunteer drivers

*A0090 = Personal Mileage Code with “UC” modifier is used to indicate volunteer mileage rate reimbursement paid only to a licensed foster parent.

**Reimbursement up to 100 percent of the IRS Business Deduction rate in place on the date-of-service.

Bus, Paratransit and Air Travel

Personal mileage codes and payment rates for bus, paratransit* and air travel

* The mileage rate begins with first mile the client is in the vehicle. Transport is by the most direct route.

** Review “Excluded Costs Related to Transportation” information to verify the transport costs do not include costs that are not reimbursable.

***R = RUCA adjustment available if conditions are met

****P = Proration applies to two or more riders picked up at the same point of origin/pickup location

Rural Urban Commuting Area Base and Mileage Adjustments (RUCA)
The RUCA add-on adjustments apply to local agency coordinated transports and reimbursements to the individual or transportation provider. Reimbursement is calculated from the zip code of the recipient’s residence. Direct billing by the transport provider to MHCP/DHS does not occur for these transports:

Mode 1 = Client Reimbursement (personal mileage/licensed foster parent mileage)

Mode 2 = Volunteer Transport

Mode 3 = Unassisted Transport (ambulatory)

Mode 4 = Assisted Transport (ambulatory)

Legal References

Minnesota Statutes, 256B.0625, subdivision 17 (Transportation costs)