Commonwealth of Massachusetts
Executive Office of Health and Human Services
Office of Medicaid
600 Washington Street Boston, MA 02111 www.mass.gov/masshealth

MASSHEALTH
TRANSMITTAL LETTER TRN-28
April 2007

TO:      Transportation Providers Participating in MassHealth FROM:      Tom Dehner, Acting Medicaid Director 
RE:      Transportation Manual (Revised Service Codes and Descriptions)

This letter transmits revisions to Subchapter 6 (service codes and descriptions) of the Transportation Manual. The revised Subchapter 6 is effective for dates of service on or after May 1, 2007.
All transportation services must be billed as one-way trips (one unit of service). The following procedure codes must be billed as one-way trips: A0100, A0120, A0130, A0130TK, A0140, T2003, A0426, and A0428. Round-trip billing will not be accepted. Instead, round trips must be billed as two one-way trips, one per claim line. For electronic 837P claim transactions, an “X” in the Ambulance Transport Code to indicate a round trip will no longer be accepted.
You must use the modifier “TS” when billing for more than two one-way trips for the same member on the same date of service. This modifier must be used with all transportation service codes when there are more than two one-way trips for the same member on the same day.
For mileage codes S0215 and A0425, the mileage limitation has been decreased to 150 miles. Any claims for more than 150 miles will suspend for agency review.
If you have any questions about the information in this transmittal letter 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.
NEW MATERIAL
(The pages listed here contain new or revised language.)
Transportation Manual
Pages vi, vii, 6-1, and 6-2
OBSOLETE MATERIAL
(The pages listed here are no longer in effect.)
Transportation Manual
Page vii — transmitted by Transmittal Letter TRN-25
Pages vi, 6-1, and 6-2 — transmitted by Transmittal Letter TRN-27

Commonwealth of Massachusetts
MassHealth
Provider Manual Series
Transportation Manual	Subchapter Number and Title
Table of Contents	Page
vi	

	Transmittal Letter
TRN-28	Date
05/01/07	
6. Service Codes 		6-1
Appendix A. Directory 		A-1
Appendix B. Enrollment Centers 		B-1
Appendix C. Third-Party Liability Codes 		C-1
Appendix W. EPSDT Services: Medical Protocol and
Periodicity Schedule 		W-1
Appendix X. Family Assistance Copayments and Deductibles 		X-1
Appendix Y. REVS/Codes Messages 		Y-1
Appendix Z. EPSDT Services Laboratory Codes 		Z-1

Commonwealth of Massachusetts
MassHealth
Provider Manual Series
Transportation Manual	Subchapter Number and Title
Preface	Page
vii	

	Transmittal Letter
TRN-28	Date
05/01/07	
The regulations and instructions governing provider participation in MassHealth are published in the Provider Manual Series. MassHealth publishes a separate manual for each provider type.
Manuals in the series contain administrative regulations, billing regulations, program regulations, service codes, administrative and billing instructions, and general information. MassHealth regulations are incorporated into the Code of Massachusetts Regulations (CMR), a collection of regulations promulgated by state agencies within the Commonwealth and by the Secretary of State. MassHealth regulations are assigned Title 130 of the Code. The regulations governing provider participation in MassHealth are assigned Chapters 400 through 499 within Title 130. Pages that contain regulatory material have a CMR chapter number in the banner beneath the subchapter number and title.
Administrative regulations and billing regulations apply to all providers and are contained in 130 CMR Chapter 450.000. These regulations are reproduced as Subchapters 1, 2, and 3 in this and all other manuals.
Program regulations cover matters that apply specifically to the type of provider for which the manual was prepared. For transportation services, those matters are covered in 130 CMR Chapter 407.000, reproduced as Subchapter 4 in the Transportation Manual.
Revisions and additions to the manual are made as needed by means of transmittal letters, which furnish instructions for making changes by hand ("pen-and-ink" revisions), and by substituting, adding, or removing pages. Some transmittal letters will be directed to all providers; others will be addressed to providers in specific provider types. In this way, a provider will receive all those transmittal letters that affect its manual, but no others.
The Provider Manual Series is intended for the convenience of providers. Neither this nor any other manual can or should contain every federal and state law and regulation that might affect a provider's participation in MassHealth. The provider manuals represent instead MassHealth’s effort to give each provider a single convenient source for the essential information providers need in their routine interaction with MassHealth and its members.

Commonwealth of Massachusetts
MassHealth
Provider Manual Series
Transportation Manual	Subchapter Number and Title
6. Service Codes and Descriptions	Page
6-1	

	Transmittal Letter
TRN-28	Date
05/01/07	
601 Service Codes and Descriptions: Dial-a-Ride Services
Service
Code	Service Description
A0120	Nonemergency transportation: mini-bus, mountain area transports, or other transportation
systems (I.C.) A0120 TS        Nonemergency transportation: mini-bus, mountain area transports, or other transportation
systems (I.C.) (when more than two one-way trips are being billed for the same member
on the same date of service)
602	Service Codes and Descriptions: Taxi Services
Service
Code	Service Description
A0100	Nonemergency transportation; taxi (Use for one passenger, intra-city transportation.)
A0100 TS        Nonemergency transportation; taxi (Use for one passenger, intra-city transportation.) (when
more than two one-way trips are being billed for the same member on the same date of
service)
603	Service Codes and Descriptions: Wheelchair Van Services
Service
Code	Service Description
A0130	Nonemergency transportation: wheelchair van
A0130 TS        Nonemergency transportation: wheelchair van (when more than two one-way trips are
being billed for the same member on the same date of service)
S0215	Nonemergency transportation; mileage, per mile (Wheelchair vans must use this code for
mileage. Do not use A0425.)
S0215 TS	Nonemergency transportation; mileage, per mile (when more than two one-way trips are
being billed for the same member on the same date of service) (Wheelchair vans must
use this code for mileage. Do not use A0425.) A0130 TK        Nonemergency transportation; wheelchair van (extra patient or passenger, non-ambulance)
(No mileage fee allowed.) A0130 TK-TS   Nonemergency transportation; wheelchair van (when more than two one-way trips are being
billed for the same member on the same date of service) (extra patient or passenger, non-
ambulance) (No mileage fee allowed.)
T2001	Nonemergency transportation; patient attendant/escort (Use for second attendant.)
T2001 TS	Nonemergency transportation; patient attendant/escort (when more than two one-way trips
are being billed for the same member on the same date of service) (Use for second
attendant.)

Commonwealth of Massachusetts
MassHealth
Provider Manual Series
Transportation Manual	Subchapter Number and Title
6. Service Codes and Descriptions	Page
6-2	

	Transmittal Letter
TRN-28	Date
05/01/07	
604 Service Codes and Descriptions: Ambulance Services
Service
Code	Service Description
Ground Mileage
A0425	Ground mileage, per statute mile (Ambulances must use this code for mileage. Do not use
S0215.)
Ambulance Service, Advanced Life Support
A0426	Ambulance service, advanced life support, nonemergency transport, level 1 (ALS 1)
A0426 TS	Ambulance service, advanced life support, nonemergency transport, level 1 (ALS 1) (when more
than two one-way trips are being billed for the same member on the same date of service)
A0427	Ambulance service, advanced life support, emergency transport, level 1 (ALS 1 – emergency)
A0427 TS	Ambulance service, advanced life support, emergency transport, level 1 (ALS 1 – emergency)
(when more than two one-way trips are being billed for the same member on the same date
of service)
A0433	Advanced life support, level 2 (ALS 2)
A0433 TS        Advanced life support, level 2 (ALS 2) (when more than two one-way trips are being billed
for the same member on the same date of service)
Ambulance Service, Basic Life Support
A0428	Ambulance service, basic life support, nonemergency transport (BLS)
A0428 TS        Ambulance service, basic life support, nonemergency transport (BLS) (when more than two
one-way trips are being billed for the same member on the same date of service)
A0429	Ambulance service, basic life support, emergency transport (BLS – emergency)
A0429 TS	Ambulance service, basic life support, emergency transport (BLS – emergency) (when more than
two one-way trips are being billed for the same member on the same date of service)
605 Service Codes and Descriptions: Other Licensed Carriers
Service
Code	Service Description
A0140	Nonemergency transportation and air travel (private or commercial), intra- or interstate
A0140 TS        Nonemergency transportation and air travel (private or commercial), intra- or interstate
(when more than two one-way trips are being billed for the same member on the same
date of service)