Medical Transportation Services
Non-emergency medical transportation (NEMT) is only available to Traditional Medicaid members for medically necessary appointments. NEMT is provided through the below sources.
The member has access to a working, licensed personal vehicle that can be used for transportation to and from covered medical services. The member must contact their DWS eligibility worker for authorization and reimbursement of covered Medicaid services.
Utah Transit Authority (UTA) services, including fixed bus routes, rapid transit, streetcar routes, TRAX, and Paratransit, may be available for members living in UTA service areas.
Members qualify for a UTA Transit Card, allowing them to utilize UTA fixed bus routes, rapid transit, streetcar routes, and TRAX for NEMT if they:
Children (under the age of 19) also qualify for a UTA Transit Card when they are enrolled in Medicaid. Parents/guardians that assist eligible children 17 years old and younger will also be eligible for a card. Members who require assistance during transportation for medical reasons are eligible for an attendant to travel with them. They will have this designated on their UTA Transit Card with the words, "Attendant: Yes".
Note: Children five years old and younger do not need a Medicaid Transit Card to utilize UTA services. The exception is those who are disabled and require an attendant. Those children will need a UTA Transit Card to identify attendants that may not be parents/guardians.
To request a UTA Transit Card, members can go to their MyBenefits account at https://mybenefits.utah.gov/ and follow the UTA Transit Card request instructions. If members do not have a MyBenefits account, they will need to contact a Health Program Representative (HPR) at 1-844-238-3091 and request a card. UTA Transit Cards will be mailed out Monday-Friday, excluding holidays. Cards requested on weekends will not be processed until the next business day.
Paratransit bus services are available for members who have a functional inability to use the regular UTA bus service, need curb-to-curb service, and live in Box Elder, Salt Lake, Weber, Davis, Tooele, or Utah counties. A member must complete a UTA evaluation to be deemed eligible to use their Paratransit service. To schedule an appointment at the UTA Mobility Center to determine functional inability to use buses and TRAX, members should call (801) 287-7433 in Salt Lake and Davis counties; Box Elder, Weber, and Tooele counties call 1-877-882-7272.
Once a member has qualified for Paratransit services, they will need to call the Medicaid Operations Office at (801) 538-6155 or 1-800-662-9651 to request monthly stickers.
Cedar Area Transportation Services (CATS) are available to members within that service area. These services include fixed bus routes and Dial-A-Ride. Members will need to provide their current Medicaid member ID to gain access to both of these services. Dial-A-Ride is available for those members who cannot use the CATS fixed bus routes, and these members must fill out an application found on the CATS website. To schedule a ride with Dial-A-Ride, members should call:
ModivCare is the statewide NEMT broker meaning ModivCare contracts with local transportation providers to provide NEMT services.
Medicaid covers NEMT services through ModivCare for members who, through a medical provider's statement, do not have regular access to a private vehicle, or live outside of UTA/CATS service areas. Members may receive ModivCare services for up to four weeks while waiting a medical provider's statement. The contractor may use the most reasonable and economical mode of transportation available and appropriate to the member's medical condition that is safe and according to state and federal laws.
General ModivCare services are available from 7:30 am to 5:30 pm, Monday-Friday. Transportation for urgent care needs is available to free-standing urgent care facilities, doctor's offices, or after-hours clinics from 7:00 am to 11:00 pm every day of the week. Limited services are available on Saturdays and holidays for members needing dialysis services.
Requests for ModivCare must be made three business days before the transportation is needed, but ModivCare cannot schedule appointments for members before approval from a DWS eligibility worker. Members should not schedule the transportation several days in advance if they are unsure they will be going to the appointment. Urgent scheduling can be done in less than three business days, but a medical provider's note may be required.
| Day of medical appointment: | Schedule with ModivCare no later than the prior: |
|---|---|
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Monday |
Wednesday |
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Tuesday |
Thursday |
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Wednesday |
Friday |
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Thursday |
Monday |
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Friday |
Tuesday |
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Saturday* |
Wednesday |
*Saturday and holiday scheduled appointments are limited to accommodate members needing dialysis or have a condition that requires routine care.
Members can schedule rides with ModivCare by phone at 1-855-563-4403, or through the website at https://www.mymodivcare.com/.
When requesting a ride, a member must provide the following:
If a member is not prepared with the required information, ModivCare may not schedule the ride. The member may be asked to call back to ModivCare with the required, missing information. At the end of the call, ModivCare will give a confirmation number for the ride and tell the member when the ride will pick them up.
In certain circumstances, ModivCare may deny a member service. In this instance, ModivCare will tell a member they have been denied during the phone call for a request for a ride. If services are denied, ModivCare sends a notice within five business days. The denial states the reason for the denial of services and will include a form explaining how to file a grievance or appeal. The member has 30 days from the postmark to file a written appeal.
Grievances may be filed directly with ModivCare at 1-855-563-4404 or on the website at https://wecare.logisticare.com/.
Please note that ModivCare transportation is not available for prescription pick-ups, unless the member is on their way home from a Medical appointment in which ModivCare was the transportation provider. Additionally, members may travel with a service animal or authorized attendant with advanced notice. If the member is a child, a parent or guardian may accompany the member, but not other family members.
American Indians residing in their tribal service area are provided NEMT through their respective Tribal NEMT Grants for the Navajo, Confederated Tribes of Goshutes, and Paiute Indian Tribe of Central Utah.
The available options for NEMT services are based on the member's needs and include UTA, Paratransit, ModivCare, ambulance, and payment for personal care mileage. To maintain cost-effectiveness while providing necessary services to Traditional Medicaid members, utilization is based on where the member lives and what services are available.
Note: A Medicaid member needs to discuss their medical transportation needs with a DWS eligibility worker as they can assist the member in finding the most effective way to get to and from appointments.
Hierarchy of NEMT:
Refer to Section I: General Information, Chapter 3, Provider Participation and Requirements.
Refer to Section I: General Information, Chapter 6, Member Eligibility, for information about how to verify a member’s eligibility, third party liability, ancillary providers, and member identity protection requirements.
All NEMT must be to the nearest appropriate Medicaid provider or facility that can provide the service.
Medicaid will authorize the most cost-effective transportation. Medicaid retains the right to determine the most appropriate means of transportation based on the information provided.
Medicaid covers emergency transportation for a nursing facility resident (nursing home). However, the facility must provide non-emergency or routine transportation.
Transfers between hospitals for Medicaid-eligible members must be medically necessary.
For coverage and reimbursement information for specific procedure codes, see the Coverage and Reimbursement Code Lookup.
Refer to Section I: General Information, Chapter 11, Billing Medicaid, for more information about billing instructions.
All claims billed to Medicaid for NEMT must have a two-digit modifier. The modifier may be any combination of the single number codes listed below, with the first indicating the origin of transportation and the second number indicating transportation destination.
| Location | Code |
|---|---|
|
Member’s home |
1 |
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Hospital |
2 |
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Practitioner’s office |
3 |
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Pharmacy |
4 |
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Lab or X-ray |
5 |
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Nursing Home |
6 |
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Medical Supplies |
7 |
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Other |
8 |
Ambulance services (ground, air, or water) are covered in the following circumstances:
Medicaid will reimburse for first aid calls when the member is not transported.
All claims billed to Medicaid for emergency transportation by ambulance must have a two-letter modifier. The modifier may be any combination of the single number codes listed below, with the first indicating the origin of transportation and the second number indicating transportation destination.
| Code | Location |
|---|---|
|
D |
Diagnostic or therapeutic site other than “P” or “H” when these are used as origin codes |
|
E |
Residential, domiciliary, custodial facility |
|
G |
Hospital-based dialysis facility (hospital or hospital-related) |
|
H |
Hospital |
|
I |
Site of transfer (e.g., airport or helicopter pad) between modes of ambulance transport |
|
J |
Non-hospital-based dialysis facility |
|
N |
Skilled nursing facility |
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P |
Physician’s office |
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R |
Residence |
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S |
Scene of an accident or acute event |
|
X |
(Destination code only) intermediate stop at the physician’s office on the way to the hospital |
Coverage is limited to base rate billed with the appropriate modifiers, mileage for the loaded ambulance only, oxygen and airway management, and, when necessary, waiting time. Charges for unloaded mileage are not reimbursable.
Round-trip ambulance transportation from one hospital to another hospital or clinic to obtain necessary diagnostic or therapeutic services when the member remains registered as an inpatient at the originating facility is non-covered. It is the responsibility of the originating hospital to cover the transportation.
Rural hospitals and Long-Term Acute Care facilities (LTACs) are excluded from this policy. In this instance, Medicaid will reimburse an ambulance service provider for round-trip facility transportation from a rural hospital or LTAC facility.
Air ambulance, whether fixed wing or helicopter, is covered in any of the following circumstances:
Water ambulance is covered in two circumstances:
Out-of-state transportation includes transportation (ground, air, or water) from Utah to another state or from another state to Utah. Medicaid only covers out-of-state transportation when the transportation cannot be provided through the contracted NEMT broker, ModivCare, and must be for a medically necessary service following Utah Administrative Code R414-1-2(18). ModivCare provides NEMT services statewide, including up to 120 miles of one-way travel into out-of-state border communities. Providers must first verify that ModivCare cannot provide out-of-state transportation services.
Coverage of out-of-state transportation requires meeting all criteria found throughout this manual, including prior authorization. The Out-of-State Transportation Prior Authorization Request Form must include:
Medicaid will not cover out-of-state transportation strictly for convenience.
When a member who is already out-of-state acutely requires medical services, transportation for returning the member to Utah is covered only when all out-of-state transportation criteria are met. For example, a member that is injured out-of-state would not qualify for transportation to Utah unless medically necessary services could not be furnished in the out-of-state treating facility or if it was determined to be more cost-effective to return the member to an in-state facility.
Upon approval of out-of-state transportation requests, the out-of-state provider and/or facility must contact the Utah Medicaid reimbursement staff before rendering services in order to determine reimbursement. The Office of Coverage and Reimbursement may be contacted at (801) 538-6094.
Out-of-state transportation travel expenses, upon prior approval, include:
Subsidized out-of-state transportation travel expenses, upon prior approval, may include:
See chapter 651-6 Rate and Method of Reimbursement of the Medicaid Eligibility Policy Manual for further details regarding coverage of out-of-state travel expenses.
For out-of-state emergency transportation, see Chapter 11, Ambulance Transportation.
When a Managed Care Entity (MCE) elects or arranges to have a member receive services from an out-of-state provider or facility, the MCE is responsible for the applicable out-of-state and return-to-state transportation and related costs for the member and, if necessary, for a parent, guardian, and/or attendant.
The MCE shall follow the out-of-state transportation criteria and related costs, including food and lodging, as outlined in this manual.
The MCE is not responsible for transportation expenses for a member who has a medical condition that occurs while out-of-state and must return to the state for treatment or services. These services are considered carved-out. See chapter 2-6 MCE Carve-Out Services of the Section I: General Information provider manual for additional information regarding requests for carve-out services.
NEMT is non-covered when transportation is requested to obtain non-covered medical services, including:
The following linked forms and attachments can also be found on the Provider Form Directory of Utah Department of Health and Human Services Medicaid website.
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Forms and Attachments |
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Updated July 2022