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RSNAT ambulance program — official procedure references

Bundled Part A transport boundary: Transport included in bundled Part A payment and not separately billed by the ambulance supplier does not need this prior authorization. Repetitive transport pattern: The repetitive pattern is at least three round trips within ten days, or at least one round trip per week for three weeks. A code alone does not establish program eligibility. Unscheduled transport can trigger review: Claims do not identify advance scheduling. Repetitive unscheduled non-emergent transport can trigger prepayment review; follow the actual additional-documentation request. Expedited RSNAT option removed: The expedited review option was removed January 9, 2025; do not offer an expedited RSNAT pathway. Affirmed trips and time period limit UTN: Use the decision letter for the affirmed trip count and period; additional trips require another request. PCS and current records: Submit a signed valid Physician Certification Statement and current supporting records; the PCS alone is not a medical-necessity determination. Request transport counts in one-way units: Request counts are assessed in one-way trips; forty round trips correspond to eighty one-way trips. This unit conversion does not establish an allowed quantity. Attestation is not sufficient evidence by itself: An attestation may replace a PCS only if it meets PCS criteria, and is valid for sixty days from physician signature. Supporting medical records are still needed. Source checked 2026-10-15. Documentary verification only; no clinical review or individual coverage determination.

Prior authorization: unknown. Member-specific applicability must be checked with the payer.
PayerCMS / Medicare
Plan contextOriginal Medicare — reference context only
ServiceRSNAT ambulance program
State scopeNot verified
Effective dateNot verified
RevisionSource 21689e408402
Retrieved10/15/2026
EvidenceOpen original source ↗

Source evidence

Documentary checks establish what the official source says, not clinical eligibility.

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Evidence fingerprint: 21689e40840222f5a21160e11f2063331bae6d6a4236983d94b2ae36df5ee329