TMPPM 2008 > Texas Medicaid Services > Ambulance > Benefits and Limitations

8.3.1.1 Prior Authorization for Emergency Out-of-State Transport

All emergency out-of-state (air and ground) transports require authorization before the transport is considered for payment.

Prior authorization for emergency transports is required for out of State providers with the exception of those providers located within 200 miles of the Texas border.

Refer to: Section 2.5, "Medicaid Service Provided Outside Texas" for additional information on providers who are not considered out-of-state providers.

To initiate the prior authorization process, providers must call 1-800-540-0694.

TMHP is responsible for processing prior authorization requests for all Medicaid clients, Primary Care Case Management (PCCM) clients, and all STAR+PLUS MQMBs.

According to 1 TAC §354.1111, nonemergency transport is defined as ambulance transport provided by an ambulance provider for a Medicaid client to or from a scheduled medical appointment, to or from another licensed facility for treatment, or to the client's home after discharge from a hospital. Non-emergency transport is appropriate when the Medicaid client's medical condition is such that the use of an ambulance is the only appropriate means of transport, e.g., alternate means of transport are medically contraindicated.