he Medicare Prior Authorization Model for Repetitive, Scheduled Non‑Emergent Ambulance Transport is being extended in the current model States of Delaware, the District of Columbia, Maryland, New Jersey, North Carolina, Pennsylvania, South Carolina, Virginia, and West Virginia for one additional year to allow for additional evaluation of the model. The model will now end in all states on December 1, 2018.
In the model States, repetitive, scheduled non-emergent ambulance transport claims with dates of service December 2, 2017 through December 4, 2017, will not be stopped for prepayment review if prior authorization is not requested before the fourth round trip in a 30-day period; however, providers may request prior authorization for these dates of service. All repetitive, scheduled non-emergent ambulance transports in the model States with a date of service on or after December 5, 2017, must have completed the prior authorization process or subsequent claims will be stopped for prepayment review if prior authorization has not been requested before the fourth round trip in a 30-day period.