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Coming Soon: TAR Submission Change for Non-Emergency Medical Transportation

July 11, 2018

Medical transportation providers rendering non-emergency medical transportation (NEMT) services will be required to enter a modifier, if applicable, on their Treatment Authorization Request (TAR) and claim:

Effective August 27, 2018: Providers will be able to include up to four modifiers with a service code when submitting a TAR for NEMT.

  • For eTARs: New modifier fields are being added in the Transportation Service Codes & Total Units section. Providers also may need to include details related to the services in the Enter Miscellaneous TAR Information field.
  • For paper TARs: The modifier is entered after the procedure code in the NDC/UPN or Procedure Code field (Box 11).
  • Note:  Currently, applicable modifiers are entered solely in the Enter Miscellaneous TAR Information field on the eTAR and the Medical Justification field (Box 8C) on the paper TAR.

Effective for dates of service on or after November 1, 2018:

  • A claim submitted for an NEMT service that includes modifiers must have an approved TAR with matching modifiers. Claims that include modifiers that are not supported by the TAR will be denied.

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.

More information and manual pages reflecting this policy will be released in a future Medi-Cal Update.