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TAR Submission Changes for Non-Emergency Medical Transportation

August 2, 2018

Effective August 27, 2018, medical transportation providers rendering non-emergency medical transportation (NEMT) services may begin entering up to four modifiers, as applicable on their Treatment Authorization Requests (TARs) and claims.

Effective for dates of service on or after November 1, 2018, providers must enter the modifiers, when applicable. Claims submitted with modifiers that are not supported by the TAR will be denied.

Placement of Modifier on TAR
The placement of the modifier on both paper and eTARs has changed from previous medical transportation instructions:

  • For eTARs: New modifier fields have been added in the Transportation Service Codes & Total Units section of the eTAR. Providers also may need to include details related to the services in the Enter Miscellaneous TAR Information field (not illustrated).
  • outpatient claim form
  • For paper TARs: The modifier is entered after the procedure code in the NDC/UPN or Procedure Code field (Box 11).
    Previously:

    For dates of service July 1, 2016 through August 26, 2018, modifiers were placed solely in the Enter Miscellaneous TAR Information field on the eTAR and the Medical Justification field (Box 8C) on the paper TAR.

Modifier 99 Disallowed
Providers are reminded that modifier 99 (multiple modifiers) is not allowed in conjunction with procedure codes associated with non-emergency medical transportation.

TARs Previously Authorized
Providers should review previously authorized TARs for non-emergency medical transportation to determine if the TAR must be end dated and a new TAR submitted with modifiers. Only TARs requesting authorization for non-emergency medical transportation services that require modifiers need to be resubmitted.

SARs Not Impacted
Service Authorization Requests (SARs) submitted by California Children’s Services and Genetically Handicapped Persons Program providers are not impacted by this authorization update. Modifiers are not required on SARs.

Providers are encouraged to subscribe to the Medi-Cal Subscription Service (MCSS) to receive notifications related to the upcoming changes. These notifications will inform and prepare providers to minimize unnecessary service disruptions. Providers may sign up for MCSS by completing the MCSS Subscriber Form.

Medical transportation Frequently Asked Questions (FAQs) #11 and #16 have been updated to reflect this information.