Non-Emergency Medical Transportation Billing Requirements

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Date: May 7, 2020
To: Health Plan of San Joaquin (HPSJ) NEMT Providers
From: HPSJ Claims Department
Subject: Non-Emergency Medical Transportation Billing Requirements
Business: Medi-Cal Managed Care

In accordance with Medi-Cal and California Department of Health Care Services (DHCS) guidelines, the following information outlines the billing requirements for all Non-Emergency Medical Transportation (NEMT) providers.

  1. Name of Referring Provider & NPI (Boxes 17a & 17b)
  2. Pick-up & Drop-Off Location with times (Box 19)
  3. Prior Authorization Number (Box 23)

Billing Sample

Night Calls (transportation between 7pm and 7am) may be reimbursed in any of the following scenarios:

  1. Transport starts during the day and ends at night (after 7pm)
  2. Entire transport occurs at night
  3. Transport starts at night and ends during the day (after 7am)

Night Call Claim Documentation must include:

  • Appropriate HCPCS Code with Modifier UJ
  • Indicate start and stop time in Additional Claim Information Field (Box 19)

Additional Claim Information FieldFor additional information and the complete billing guide for transportation services, please visit the Medi-Cal website and follow the link below.

If you have questions, please contact our Customer Service Department at 209-942-6320.

Posted on May 8th, 2020 and last modified on May 8th, 2020.