Covered Services
In order to be approved for Non-Emergency Transportation services, the Participant must be transported to an appointment where they will receive a covered medical service. A covered medical service is a Medicaid Eligible Medical Service (MEMS).
Examples of Covered and non-covered services are:
Covered Services
- Chemotherapy
- Radiation
- Wellness exam, or annual physical exam
- Glaucoma, Cataracts
- X-Rays, MRI, CAT scan, or other diagnostic Testing
- Blood test
- Hospital admit or discharge
- Sleep study
- Outpatient surgery
- IV infusion
- Birth control
- Prenatal care
- Gastrointestinal problems
Covered Services with Limitations
| Emergency room (ER) transports | Only approvable if the Participant was referred to the ER by a physician. The referral must be validated before the request can be approved. You will need to provide Transdev with the name and phone number of the referring physician. |
| Prosthetic device fitting | The Participant must be seeing a licensed, certified, health professional; this must be validated by Transdev before the request can be approved. |
| Prosthetic device pick-up | The Participant must be seeing a licensed, certified, health professional and the professional must be performing an adjustment during the visit; this needs to be validated by Transdev before the request can be approved. |
| Diabetic teaching; dietician or nutritionist visit | Each is allowed once per Participant per lifetime. |
| Flu shots/vaccinations | Must be given by a physician or at a medical facility (not a pharmacy or grocery store) and the Participant must be either a) under 21 years old, b) 22 to 64 years old – only if there is an underlying medical condition which the medical provider believes places the Participant at risk, or c) 65 years old or older |
| WIC (supplemental program for Women, Infants, & Children) | The Participant must be receiving a covered service such as a well child checkup (not just picking up supplies, signing up for benefits, or picking up coupons). |
| Abortion services | Adjudicated on a case-by-case basis. |
| LTC admit or discharge | The Participant cannot be transported out of personal or family choice or convenience. The Request will be evaluated on a case-by-case basis. |
| Hospital to hospital transports | Must be one-way and the Participant must be receiving a Higher Level of Care, that is, inpatient services not available at the originating hospital. Hospital to hospital transports via non-emergency ambulance do not require prior authorization from Transdev. NET Providers may bill HFS directly. |
| Wheelchair fitting | The Participant must be seeing a licensed, certified, health professional; this needs to be validated by Transdev before the request can be approved. |
| Wheelchair pickup | Approvable ONLY if the wheelchair cannot be delivered and if the Participant is receiving instructions; this must be validated by Transdev before the request can be approved. |
| Eye glass fitting and pickup | Must be getting an exam or be fitted at time of pickup. For Participants 21 years of age or older the coverage is limited to once every two years. |
| Group Behavioral Health Services | Limited to 2 round trips per week. Not covered for residents 21 years or older residing at a long term care facility. |
| Tobacco Cessation Counseling Services | Covered for:
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Non-Covered Services
(Please note, this is not a full list)
- Massage therapy
- Prescription pickup
- Social Security / SSI medical evaluation
- Wheelchair Repair
- Smoking cessation for non pregnant women and Participants 21 and older
- Day care (child or adult)
- Acupuncture
- Flu shots or vaccinations at local pharmacies
- Methadone pickup or treatment
- Transportation for Emergency services is not covered under NETSPAP. Refer to the handbook for Transportation Services T-200 for emergency transportation procedures.
- One-way hospital to hospital Transports NOT receiving a Higher Level of Care at the destination hospital
- Round-trip hospital to hospital transports; the transportation provider must seek payment from the inpatient hospital.
- ‘No Show’ trips (patient was not transported or was transported but not seen by the medical doctor)
- Transportation for a Participant who has been declared deceased
- Medical transportation provided for patients who reside in state-operated facilities; the transportation provider must seek payment from the state-operated facility
- Artificial insemination
- Medical or surgical transsexual treatment services
- Preparation of routine records, forms and reports
- Services provided only, or primarily, for the convenience of patients or their families
- Equipment pickup, such as walkers, crutches, bed pans, sick room supplies, etc
- Pick up for filling prescriptions or any other pharmacy-related item
- Experimental procedures
- Infertility/sterility diagnostic or therapeutic procedures
- Early intervention services
- Sheltered workshops
- Social rehabilitation programs
- Day training programs
- Cosmetic medical treatments
- Gym
- Group therapy for Participants 21 years of age or older who reside in a long term care facility
