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Prior Authorization

Prior Authorization of Repetitive Scheduled Non-Emergent Ambulance Transport (RSNAT)

RSNAT Prior Authorization Form and Information

Ambulance Repetitive Service

Repetitive ambulance services are defined as ambulance transportation that is medically necessary which is furnished 3 or more round trips in a ten-day period or at least one round trip per week for at least 3 weeks.


The purpose of the prior authorization helps ambulance providers ensure services provided will comply with Medicare coverage, coding, and billing requirements under Part B. This process will allow providers and suppliers an opportunity to address concerns with claims prior to providing the service. Ambulance suppliers will know up front if their claims will be properly reimbursed.


The RSNAT prior authorization model applies to the following HCPC codes:

  • A0426 Advanced Life Support (ALS) Level 1 non-emergency transport
  • A0428 Basic Life Support (BLS) non-emergency transport.

Ambulance Benefit

The Medicare ambulance benefit is not changing for non-emergent transports. Non-emergent transports are limited and designed only for patients who are clinically unable to transport themselves by other means. The patient's condition must be medically necessary and require both the transport and level of service provided. The patient must be transported to a Medicare covered destination where the patient receives a covered service.

Documentation Requirements

Documentation requirements are not changing. The same information is required:

  • Signed Physician Certification Statement (PCS)
  • Current documentation from the medical record to support medical necessity

Information on coverage and documentation requirements are located at:

Prior Authorization Process

The prior authorization process is voluntary for independent ambulance suppliers. However, if a supplier elects not to submit a prior authorization request before the 4th round trip, all related claims will be subject to a prepayment medical review.

An ambulance supplier can request up to 40 round trips in a 60-day period per prior authorization request. Once CGS has received all the relevant documentation and reviewed the request, suppliers and patients will be notified of the decision (affirmed or non-affirmed) within 10 business days.

When submitting a claim, an ambulance supplier needs to include the unique tracking number (UTN). The UTN is located on the decision letter received from CGS. It needs to be a valid affirmed UTN to receive payment. A claim with a non-affirmed UTN will be denied. All appeals rights are then available.

Recorded Webinar Sessions

October 31, 2022
Repetitive, Scheduled Non-Emergent Ambulance Transport (RSNAT) Overview

For questions, email:



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