Ambulance RSNAT Prior Authorization

Published 07/24/2026

Repetitive, Scheduled Non-Emergent Ambulance Transport (RSNAT) Prior Authorization (PA). RSNAT transports are defined as medically necessary ambulance transports that occur three times or more during a 10-day period or at least once per week for three weeks or longer.

Last Reviewed: 07/24/2026

The RSNAT PA model began in the states of New Jersey, Pennsylvania and South Carolina on December 1, 2014. The model was expanded nationwide to all states by August 2022.

The RRB SMAC implemented the RSNAT PA model on July 18, 2022, for Railroad Medicare beneficiaries nationwide for transports on and after August 1, 2022.

Last Reviewed: 07/24/2026

CMS began operating the RSNAT PA model to test whether PA of RSNAT services covered under Medicare Part B would lower program spending, while maintaining or improving quality patient care. It is designed to ensure that all relevant coverage, coding and medical record(s) requirements are met before the service is rendered to patients and before claims are submitted for payment. Therefore, this model can assist in reducing appeals for claims that may otherwise be denied.

Last Reviewed: 07/24/2026

The following ambulance HCPCS codes are subject to prior authorization:

  • A0426: Ambulance service, Advanced Life Support (ALS), non-emergency transport, Level 1
  • A0428: Ambulance service, Basic Life Support (BLS), non-emergency transport

HCPCS code A0425 is considered an associated service and will not receive prior authorization.

Last Reviewed: 07/24/2026

By submitting a complete cover sheet and required documentation, a supplier can receive provisional prior authorization for as many as 40 round trips or 80 one-way transports in a 60-day period. For scheduled trips beyond the PA number, a second PA request is required.

Last Reviewed: 07/24/2026

Prior authorization does not create new clinical documentation requirements. Instead, it requires the same information that is already required to support Medicare payment, just earlier in the process. This includes, but is not limited to, a signed and valid PCS and current documentation from the patient’s medical record to support medical necessity of RSNAT PA services.

Last Reviewed: 07/24/2026

Prior authorization for RSNAT is voluntary. However, if suppliers do not submit a prior authorization request for a beneficiary before their fourth-round trip within a 30-day period, their claims related to RSNATs will be subject to prepayment medical review.

Participation in this model is recommended. Prior authorization helps ambulance suppliers ensure that their services comply with applicable Medicare coverage, coding and payment rules before services are rendered and before claims are submitted for payment. This model allows providers and suppliers the opportunity to address issues with claims prior to rendering services and submitting claims for payment, which has the potential to reduce appeals for claims that may otherwise be denied. Ambulance suppliers are encouraged to submit prior authorization request prior to the beneficiary’s fourth trip in a 30-day period.

Last Reviewed: 07/24/2026

Requests may be submitted via mail or fax, through the Palmetto GBA eServices portal, or through the Electronic Submission of Medical Documentation (esMD) system. Please see our article about requesting PA for RSNAT for more information.

Last Reviewed: 07/24/2026

With the implementation of CR 13711 (PDF) on January 9, 2025, after receipt of all relevant documentation, MACs will make every effort to review and postmark the notification of their decision to the ambulance supplier and the beneficiary within seven calendar days for all RSNAT PA requests.

Last Reviewed: 07/24/2026

Yes. Each completed prior authorization request is assigned a 14-byte unique tracking number (UTN). This number is included on the decision letter and will be used when submitting claims. A non-affirmed UTN will also be used when you send a resubmission for a non-affirmed PA request.

Last Reviewed: 07/24/2026

A provisional affirmative prior authorization decision affirms a specified number of trips within a specific amount of time and can be for all or part of a requested number of trips. The prior authorization decision, justified by the beneficiary’s condition, may affirm up to 40 round trips (which equates to 80 one-way trips) per prior authorization request in a 60-day period. Transports exceeding 40 round trips (or 80 one-way trips) in a 60-day period will require an additional prior authorization request.

MACs may consider an extended affirmation period for beneficiaries with a chronic medical condition that is deemed not likely to improve over time. The prior authorization decision, justified by the beneficiary’s chronic medical condition, may affirm up to 120 round trips (which equates to 240 one-way trips) per prior authorization request in a 180-day period. Ambulance suppliers are still responsible for maintaining a valid PCS at all times.

Last Reviewed: 07/24/2026

You can find additional information on our Ambulance Prior Authorization page and in the following CMS resources:

Last Reviewed: 07/24/2026


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