Commonwealth of Massachusetts
Executive Office of Health and Human Services
Office of Medicaid
www.mass.gov/masshealth

MassHealth
All Provider Bulletin 218
October 2011

TO:	All Providers Participating in MassHealth
FROM:	Julian J. Harris, M.D., Medicaid Director
RE:	Service Animal Indication on the Prescription for Transportation (PT-1) Form


Background
MassHealth providers completing the Prescription for Transportation 
(PT-1) form on behalf of a MassHealth member to request authorization 
for transportation to medical services, should indicate on the PT-1 if the 
member will be accompanied by a service animal.


Completion of the PT-1 Form
To indicate that a member will be accompanied by a service animal, 
providers should enter “Service Animal” in Section 7 (Other Information) 
of the PT-1 form in the field “Specify other transportation needs.” 

The PT-1 form is fillable online. We encourage you to submit your PT-1 
requests electronically instead of by fax or mail. For more information 
about requesting nonemergency transportation for a member online, 
please see MassHealth All Provider Bulletin 157.


Questions
If you have any questions about the information in this bulletin, please 
contact MassHealth Customer Service at 1-800-841-2900, e-mail your 
inquiry to providersupport@mahealth.net, or fax your inquiry to 
617-988-8974.