Wheelchair, ambulatory and stretcher trips: space types and what each needs from dispatch and billing

For Medi-Cal NEMT, the member's provider decides, not the transportation company. The Physician Certification Statement (PCS) form names the mode of transport the member needs. Under DHCS All Plan Letter 22-008, plans must authorize the lowest-cost mode that is adequate for the member's medical needs, as the medical professional determines, and neither the plan nor its broker may change or downgrade the mode on the PCS. If the member's condition changes, a new PCS is needed, even to move to ambulatory.

For you, that means the space type on the trip should match the authorization. A rider authorized for a wheelchair van who arrives at the curb walking is still a wheelchair van trip on paper; if that keeps happening, it is for the plan and the member's provider to look at, not for dispatch to change on its own.

An ambulatory rider can walk and sit in an ordinary seat. In Medi-Cal, a member who can travel by ordinary means gets non-medical transportation (NMT), which plans provide by passenger car, taxicab or other ordinary vehicles, and which needs no PCS form. An ambulatory member who needs door-to-door help because of a disabling physical or mental limitation can qualify for NEMT instead, with a PCS. A plan approves NMT itself and may re-authorize it every 12 months. NMT can cover one attendant, such as a parent, guardian or spouse, when approved with the request.

For dispatch, ambulatory riders are the easiest to share a vehicle, since they fit in any seat. Watch the details that still matter: a rider who needs door-to-door help, a walker that needs space, an attendant who takes a seat.

The PCS form used by CalViva Health and Health Net describes the wheelchair van as for a patient who is a wheelchair user and needs a lift-equipped or roll-up wheelchair vehicle. Health Plan of San Joaquin's policy lists some of the members who may qualify with a signed PCS: members with severe mental confusion, members with paraplegia, dialysis recipients, and members with chronic conditions who need oxygen but not monitoring.

• Vehicle: a lift or ramp and securements for each wheelchair position. Check each payer's and broker's inspection list for the equipment it requires.
• Dispatch: count wheelchair positions separately from seats. A van with two positions can take two wheelchairs and some ambulatory riders, not four wheelchairs. Loading and securing takes longer than a walk-on, so plan more time at each stop.
• Billing: in Medi-Cal, the wheelchair van base code is A0130, and mileage is A0380 per statute mile. See Medi-Cal NEMT billing codes.

The same PCS form describes the gurney, litter or stretcher van as for a patient who is confined to a bed and cannot sit in a wheelchair, but does not need medical attention or monitoring during transport. That last part is the line with ambulance service: a bed-confined patient who needs monitoring, such as for non-self-administered oxygen or sedation, is described under basic life support ambulance instead.

• Vehicle: configured to carry a gurney, with the crew the payer requires. Availability varies by county; Health Plan of San Joaquin's policy notes litter van service is not available in its area because of a county ordinance.
• Dispatch: count stretcher positions on their own, plan longer loading and unloading, and make sure the facility's staff are ready for the transfer.
• Billing: in Medi-Cal, the stretcher van code is T2005, and mileage is A0380, the same mileage code as wheelchair vans.

Separate from the space type, many payers set how much help the driver gives: curb-to-curb, door-to-door, door-through-door or hand-to-hand. A wheelchair rider might need door-through-door help into a dialysis center, while another needs only curb-to-curb. Plans check this. Health Plan of San Joaquin, for example, lists whether NEMT members receive door-to-door service among the things it monitors each quarter. Keep the service level on the rider's profile, and let it add to the stop time in planning.

1. Every vehicle's capacity by space type, not just a seat count, and every change, such as a lift out of service.
2. Every rider's space type, equipment and service level on their profile, so a new trip starts correct.
3. A check before a trip is assigned: does the van have the right free space at that moment of the run, counting who is already on board?
4. Stop times that differ by space type, so the run's later pickups are not late on paper from the first wheelchair stop.
5. Payer rules on which space types they authorize and pay, so a trip is not done for a payer that will not pay for that mode.

Most capacity mistakes show up as late pickups, since the wrong van is sent and the right one is found later. Our post on pickup windows covers how to keep the run on time.

In MileCall, each vehicle carries its capacity by space type, and rider profiles keep needs, equipment and notes for the driver. Before a trip is assigned, the rules check pickup windows, ride-time limits and space by type, and payer contract rules such as allowed space types can warn or block. Payer rates are set per leg, per loaded mile, per minute of wait and per attendant, by space type. See MileCall dispatch and MileCall billing.

1. All Plan Letter 22-008: Non-Emergency Medical and Non-Medical Transportation Services and Related Travel Expenses (DHCS)
2. Provider Update 22-972: Action required for NEMT requests (APL 22-008 summary and PCS form) (CalViva Health and Health Net, Medi-Cal plans)
3. Policy UM55: Emergency Transportation, Non-Emergency Medical Transportation and Related Expenses (Health Plan of San Joaquin, a Medi-Cal plan)
4. Ground emergency transportation and non-emergency transportation billing and documentation requirements (June 2024) (Health Plan of San Joaquin, a Medi-Cal plan)
5. Medi-Cal Provider Manual, Part 2: Medical Transportation – Ground (DHCS, Medi-Cal)
6. Medi-Cal Provider Manual, Part 2: Medical Transportation – Ground: Billing Codes and Reimbursement Rates (DHCS, Medi-Cal)

This post explains how things work in general; it is not legal, medical or billing advice. Rules change and differ by payer, so check your payer’s current manual and your contract before you rely on any detail here.