Non-Emergency Medical Transportation: Resubmitting TARs with Modifier(s)
August 15, 2018
Treatment Authorization Requests (TARs) previously submitted and approved for non-emergency medical transportation (NEMT) services for dates of service on or after November 1, 2018, may need to be resubmitted. If the NEMT service requires modifier(s) to be reimbursed and the TAR was submitted without the required modifier(s), the TAR should be end dated and a new one submitted with the correct modifier(s). Modifiers on NEMT TARs and claims must match or the claims will be denied.
Modifiers: Optional Versus Required
Providers were notified that beginning August 27, 2018, they could begin submitting TARs with up to four modifiers. For dates of service August 27, 2018, through October 31, 2018, inclusion of modifiers is optional. For dates of service on or after November 1, 2018, modifiers will be required.
Placement of Modifier(s) on TAR
The placement of modifier(s) on both eTARs and paper TARs is as follows:
- For eTARs: New modifier fields have been added in the Medical 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).
- For paper TARs: The modifier is entered after the procedure code in the NDC/UPN or Procedure Code field (Box 11).
For TARs submitted on or before 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.
Medical transportation Frequently Asked Questions (FAQs) #11 and #16 have been updated to reflect this information.
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.
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 changes. The notifications help inform and prepare providers to minimize unnecessary service disruptions. Providers may sign up for MCSS by completing the MCSS Subscriber Form.