Medicaid Benefits: Non-Emergency Medical Transportation Services

This data is presented as an interactive tool that allows users to: filter by timeframe/year, select specific data columns (distributions), filter by state or geography, and view the data as a table, map, or trend chart.

2018

Location	Benefit Covered	Coverage Code	Copayment Required?	Limits on Services	Prior Approval Required	Reimbursement Methodology
United States	Yes - 46 No - 0 NR - 5	2018 data limited to CN	Yes - 5	Yes - 22	Included in "Limits on Services" for 2018	Not included in 2018 survey
Alabama	Yes	CN	No	No	-	-
Alaska	Yes	CN	No	Requires prior authorization	-	-
Arizona	Yes	CN	No	Necessary and no other means of transportation	-	-
Arkansas	Yes	CN	No	Yes - Not Specified	-	-
California	Yes	CN	No	Specialized transportation requires prescription from a provider; non-specialized transportation requires the beneficiary to attest that other resources have been reasonably exhausted	-	-
Colorado	Yes	CN	No	No	-	-
Connecticut	Yes	CN	No	Transportation for the member's family will be covered if they needs to be present for services, such as family services.	-	-
Delaware	Yes	CN	No	For medical appointments only	-	-
District of Columbia	Yes	CN	No	Requires a physician certification for certain services.	-	-
Florida	Yes	CN	$1 copayment per one-way trip	No	-	-
Georgia	Yes	CN	$1 copay	No	-	-
Hawaii	Yes	CN	No	No	-	-
Idaho	Yes	CN	No	No	-	-
Illinois	NR	NR	NR	NR	NR	NR
Indiana	Yes	CN	$.50-$2/ non-emergency transport, depending on payment	Prior authorization on non-emergency transports beyond 20 one-way trips/year and non-emergency transports greater than 50 miles.	-	-
Iowa	NR	NR	NR	NR	NR	NR
Kansas	Yes	CN	No	No	-	-
Kentucky	Yes	CN	No	Not available if there is a working vehicle in the household.	-	-
Louisiana	Yes	CN	No	NR	-	-
Maine	Yes	CN	No	No	-	-
Maryland	Yes	CN	No	No	-	-
Massachusetts	Yes	CN	No	No	-	-
Michigan	Yes	CN	No	Contracted broker responsible for NEMT in 3 counties in SE Michigan (Wayne, Oakland and Macomb counties) for FFS only	-	-
Minnesota	Yes	CN	No	No	-	-
Mississippi	Yes	CN	No	NR	-	-
Missouri	Yes	CN	$2	Traditional Medicaid Adults are covered for Non-Emergency Medical Transportation to Missouri HealthNet covered services only	-	-
Montana	Yes	CN	No	All NEMT services are reviewed for medical necessity	-	-
Nebraska	Yes	CN	No	No	-	-
Nevada	Yes	CN	No	No	-	-
New Hampshire	NR	NR	NR	NR	-	-
New Jersey	Yes	CN	No	Requires prior authorization	-	-
New Mexico	Yes	CN	No	No	-	-
New York	NR	NR	NR	NR	-	-
North Carolina	Yes	CN	No	Arranged by local DSS, No NCHC, limit to one procedure per date/time/with same or different provider	-	-
North Dakota	Yes	CN	No	Prior authorization required for all transportation services.	-	-
Ohio	Yes	CN	No	No	-	-
Oklahoma	Yes	CN	No	NR	-	-
Oregon	Yes	CN	No	Brokerage verifies things such as client does not have access to other means of transport, service is within the local area, verification of appointment, etc	-	-
Pennsylvania	Yes	CN	No	Transportation limited to services covered under the Medical Assistance Program	-	-
Rhode Island	Yes	CN	No	No	-	-
South Carolina	NR	NR	NR	NR	-	-
South Dakota	Yes	CN	No	NR	-	-
Tennessee	Yes	CN	No	No	-	-
Texas	Yes	CN	No	Medical Transportation Program requires authorization through the state	-	-
Utah	Yes	CN	No	No	-	-
Vermont	Yes	CN	No	Limited to transportation requests fulfilled by brokers; members must not have access to another means of transportation to the medical service; the medical service must be covered by Medicaid, medically necessary and provided by a Medicaid provider; coverage limited to least expensive means of transportation suitable to the individual’s medical needs; requests for transportation must be made with enough advance notice to schedule the ride (at least 48 hours in advance of the appointment)	-	-
Virginia	Yes	CN	No	NR	-	-
Washington	Yes	CN	No	Requires prior authorization	-	-
West Virginia	Yes	CN	No	Non-emergency medical transportation will be provided by a single contracted transportation broker to the nearest medically appropriate and qualified provider not to exceed 125 miles from the members home in state or within 30 miles of the West Virginia border.	-	-
Wisconsin	Yes	CN	$1.00 per trip in a specialized medical vehicle; $2 per trip for non-emergency ambulance; no copayment for transportation by common carrier	Non-emergency transportation services approved and coordinated by a transportation manager	-	-
Wyoming	Yes	CN	No	No	-	-

2012

Location	Benefit Covered	Coverage Code	Copayment Required?	Limit on services days	Prior Approval Required	Reimbursement Methodology
United States	Yes - 56 No - 0		Yes - 5 No - 51
Alabama	Yes	CN		2 trips/month	Transports greater than 100 miles one way	See service-specific FN
Alaska	Yes	CN			Yes	See service-specific FN
American Samoa	Yes	See territory-specific FN		On-island services provided by Governmernt Emergency Medical Services when necessary. Off-island services coordinated through Medicaid agency
Arizona	Yes	CN & MN				See service-specific FN
Arkansas	Yes	CN & MN				See service-specific FN
California	Yes	CN & MN		Limited to beneficiaries medically unable to use normal public or private transportation	Yes	See service-specific FN
Colorado	Yes	CN				See service-specific FN
Connecticut	Yes	CN & MN			Yes	See service-specific FN
Delaware	Yes	CN				Capitated rate paid to transportation broker
District of Columbia	Yes	CN & MN			Medi-van transport	See service-specific FN
Florida	Yes	CN & MN	$1/trip each way	Limited to beneficiaries unable to arrange for medically necessary transportation through any other means	Yes	Services coordinated by a transportation broker paid fixed fee; see service-specific FN
Georgia	Yes	CN & MN				Services coordinated by transportation brokers - see service-specific FN
Guam	Yes	CN		With limitations		Fee for service using Medicare fee schedule or negotiated rate
Hawaii	Yes	CN & MN			Yes	See service-specific FN
Idaho	Yes	CN			Yes	See service-specific FN
Illinois	Yes	CN & MN			Yes	See service-specific FN
Indiana	Yes	CN	$.50-$2/trip, depending on payment	20 one-way trips less than 50 miles/year		See service-specific FN
Iowa	Yes	CN & MN				See service-specific FN
Kansas	Yes	CN & MN			Specified modes of travel	See service-specific FN
Kentucky	Yes	A, B & C - See state-specific FN			Yes	See service-specific FN
Louisiana	Yes	CN & MN			Yes	See service-specific FN
Maine	Yes	CN & MN			Out of state transports	See service-specific FN
Maryland	Yes	CN & MN			Yes	Grants to local health departments - see service-specific FN
Massachusetts	Yes	CN & MN				See service-specific FN
Michigan	Yes	CN & MN				Services coordinated by a transportation broker in select counties - see service-specific FN
Minnesota	Yes	A - See state-specific FN				See service-specific FN
Mississippi	Yes	CN			Yes	Services coordinated by transportation broker - see service-specific FN
Missouri	Yes	CN	$2/trip			See service-specific FN
Montana	Yes	A & B - See state-specific FN			Yes	See service-specific FN
Nebraska	Yes	CN & MN			Yes	Services coordinated by a transportation broker paid on a completed trip basis; transportation providers paid fee for service; see service-specific FN
Nevada	Yes	CN			Yes	Services coordinated by a transportation broker paid on a capitation basis; see service-specific FN
New Hampshire	Yes	CN & MN		24 wheelchair van trips/year		Fee for service using base rate plus mileage - see service-specific FN
New Jersey	Yes	CN & MN			Yes	Services coordinated by a transportation broker paid on a capitation basis; see service-specific FN
New Mexico	Yes	CN		Transportation to pharmacy for prescription pick-up not covered, A - this benefit is not covered		See service-specific FN
New York	Yes	CN & MN			Yes	Services coordinated by a transportation broker paid on a capitation basis; see service-specific FN
North Carolina	Yes	CN & MN				Payment made to counties - see service-specific FN
North Dakota	Yes	CN & MN				See service-specific FN
Northern Mariana Islands	Yes	CN & MN - See territory-specific FN
Ohio	Yes	CN				County office staff coordinate and pay for transportation - see service-specific FN
Oklahoma	Yes	CN				Services coordinated by a transportation broker paid on a capitation basis; see service-specific FN
Oregon	Yes	A - See state-specific FN		Limited rides for covered services	Yes	Cost per ride rate paid to transportation broker
Pennsylvania	Yes	CN & MN	$.65-$3.80/service, depending on payment rate			Services coordinated by a transportation broker and paid on a capitation basis in selected geographic areas; see service-specific FN
Puerto Rico	Yes					Service is included in the capitated rate paid to managed care plans
Rhode Island	Yes	See state-specific FN			Yes	Services arranged by a transportation broker that operates a call center but is not paid for the transportation; see service-specific FN
South Carolina	Yes	CN				Services coordinated by a transportation broker paid on a capitation basis; see service-specific FN
South Dakota	Yes	CN				Transportation providers paid on mileage basis - see service-specific FN
Tennessee	Yes	A, B & C - See state-specific FN				See service-specific FN
Texas	Yes	CN & MN			Specified services	Fee for service or capitation, services in selected areas of the state coordinated by a transportation broker; see service-specific FN
Utah	Yes	A - See state-specific FN				Services coordinated by a transportation broker paid on a capitation basis; see service-specific FN
Vermont	Yes	A - See state-specific FN			Yes	See service-specific FN
U.S. Virgin Islands	Yes	CN				See service-specific FN
Virginia	Yes	CN & MN			Yes	Services coordinated by a transportation broker paid on a capitation basis; see service-specific FN
Washington	Yes	CN & MN			Yes	Services coordinated by a transportation broker in selected counties that is paid an administrative fee plus pass-through amounts for providers and clients, see service-specific FN
West Virginia	Yes	A, B & C			Yes	See service-specific FN
Wisconsin	Yes	CN & MN	$1/trip in specialized medical vehicle, $2/trip in ambulance		Trips exceeding 4 weeks	Fee for service or capitation, most services coordinated by a transportation broker; see service-specific FN
Wyoming	Yes	CN				See service-specific FN

2010

Location	Benefit Covered	Coverage Code	Copayment Required?	Limit on services days	Prior Approval Required	Reimbursement Methodology
United States	Yes - 55 No - 1		Yes - 6 No - 49
Alabama	Yes	CN		2 trips/month		See service-specific FN
Alaska	Yes	CN			Yes	See service-specific FN
American Samoa	Yes	See territory-specific FN
Arizona	Yes	CN & MN				See service-specific FN
Arkansas	Yes	CN & MN				See service-specific FN
California	Yes	CN & MN		Limited to beneficiaries medically unable to use normal public or private transportation	Yes	See service-specific FN
Colorado	Yes	CN				See service-specific FN
Connecticut	Yes	CN & MN			Yes	See service-specific FN
Delaware	Yes	CN				Capitated rate paid to transportation broker
District of Columbia	Yes	CN & MN			Medi-van transport	See service-specific FN
Florida	Yes	CN & MN	$1/trip each way	Limited to beneficiaries unable to arrange for medically necessary transportation through any other means	Yes	See service-specific FN
Georgia	Yes	CN & MN	$1/trip			See service-specific FN
Guam	No
Hawaii	Yes	CN & MN			Yes	See service-specific FN
Idaho	Yes	CN			Yes	See service-specific FN
Illinois	Yes	CN & MN			Yes	See service-specific FN
Indiana	Yes	CN	$.50-$2/trip, depending on payment	20 one-way trips less than 50 miles/year		See service-specific FN
Iowa	Yes	CN & MN				See service-specific FN
Kansas	Yes	CN & MN			Specified modes of travel	See service-specific FN
Kentucky	Yes	A, B & C - See state-specific FN			Yes	See service-specific FN
Louisiana	Yes	CN & MN			Yes	See service-specific FN
Maine	Yes	CN & MN			Out of state transports	See service-specific FN
Maryland	Yes	CN & MN			Yes	See service-specific FN
Massachusetts	Yes	CN & MN				See service-specific FN
Michigan	Yes	CN & MN				See service-specific FN
Minnesota	Yes	A - See state-specific FN				See service-specific FN
Mississippi	Yes	CN			Yes	See service-specific FN
Missouri	Yes	CN	$2/trip			See service-specific FN
Montana	Yes	A & B - See state-specific FN			Yes	See service-specific FN
Nebraska	Yes	CN & MN			Yes	See service-specific FN
Nevada	Yes	CN			Yes	See service-specific FN
New Hampshire	Yes	CN & MN		24 wheelchair van trips/year		See service-specific FN
New Jersey	Yes	CN & MN			Yes	See service-specific FN
New Mexico	Yes	CN		Transportation to pharmacy for prescription pick-up not covered, A - this benefit is not covered		See service-specific FN
New York	Yes	CN & MN			Yes	See service-specific FN
North Carolina	Yes	CN & MN				See service-specific FN
North Dakota	Yes	CN & MN				See service-specific FN
Northern Mariana Islands	Yes	CN & MN - See territory-specific FN
Ohio	Yes	CN				See service-specific FN
Oklahoma	Yes	CN				See service-specific FN
Oregon	Yes	A - See state-specific FN		Limited rides for covered services	Yes	See service-specific FN
Pennsylvania	Yes	CN & MN	$.50-$3/service, depending on payment			See service-specific FN
Puerto Rico	Yes					Service is included in the capitated rate paid to managed care plans
Rhode Island	Yes	See state-specific FN			Yes	See service-specific FN
South Carolina	Yes	CN				See service-specific FN
South Dakota	Yes	CN				See service-specific FN
Tennessee	Yes	A & B - See state-specific FN				See state-specific FN
Texas	Yes	CN & MN			Specified services	See service-specific FN
Utah	Yes	A - See state-specific FN				See service-specific FN
Vermont	Yes	A - See state-specific FN			Yes	See service-specific FN
U.S. Virgin Islands	Yes	CN				See service-specific FN
Virginia	Yes	CN & MN			Yes	See service-specific FN
Washington	Yes	CN & MN			Yes	See service-specific FN
West Virginia	Yes	A, B & C			Yes	See service-specific FN
Wisconsin	Yes	CN & MN	$1/trip in specialized medical vehicle		Trips exceeding 4 weeks	See service-specific FN
Wyoming	Yes	CN				See service-specific FN

2008

Location	Benefit Covered	Coverage Code	Copayment Required?	Limit on services days	Prior Approval Required	Reimbursement Methodology
United States	Yes - 54 No - 2		Yes - 7 No - 47
Alabama	Yes	CN		2 trips/month		See service-specific FN
Alaska	Yes	CN			Yes	See service-specific FN
American Samoa	Yes	See territory-specific FN
Arizona	Yes	CN & MN			Yes	See service-specific FN
Arkansas	Yes	CN & MN				See service-specific FN
California	Yes	CN & MN			Yes	See service-specific FN
Colorado	Yes	CN				See service-specific FN
Connecticut	Yes	CN & MN			Yes	See service-specific FN
Delaware	Yes	CN	$1/trip			See service-specific FN
District of Columbia	Yes	CN & MN			Medi-van transport	See service-specific FN
Florida	Yes	CN & MN	$1/trip each way	Limited to beneficiaries unable to arrange for medically necessary transportation through any other means	Yes	See service-specific FN
Georgia	Yes	CN & MN	$1/trip			See service-specific FN
Guam	No
Hawaii	Yes	CN & MN			Yes	See service-specific FN
Idaho	Yes	CN			Yes	See service-specific FN
Illinois	Yes	CN & MN			All transports other than nursing facility residents	See service-specific FN
Indiana	Yes	CN	$.50-$2/trip, depending on payment	20 one-way trips less than 50 miles/year		See service-specific FN
Iowa	Yes	CN & MN				See service-specific FN
Kansas	Yes	CN & MN			Specified modes of travel	See service-specific FN
Kentucky	Yes	A, B & C - See state-specific FN			Yes	See service-specific FN
Louisiana	Yes	CN & MN			Yes	See service-specific FN
Maine	Yes	CN & MN			Transportation of nursing facility residents	See service-specific FN
Maryland	Yes	CN & MN			Yes	See service-specific FN
Massachusetts	Yes	CN & MN				See service-specific FN
Michigan	Yes	CN & MN				See service-specific FN
Minnesota	Yes	A - See state-specific FN				See service-specific FN
Mississippi	Yes	CN			Yes	See service-specific FN
Missouri	Yes	CN	$2/day			See service-specific FN
Montana	Yes	A & B - See state-specific FN			Yes	See service-specific FN
Nebraska	Yes	CN & MN			Yes	See service-specific FN
Nevada	Yes	CN			Yes	See service-specific FN
New Hampshire	Yes	CN & MN		24 wheelchair van trips/year		See service-specific FN
New Jersey	Yes	CN & MN			Yes	See service-specific FN
New Mexico	Yes	CN		Transportation to pharmacy for prescription pick-up not covered		See service-specific FN
New York	Yes	CN & MN			Yes	See service-specific FN
North Carolina	Yes	CN & MN				See service-specific FN
North Dakota	Yes	CN & MN				See service-specific FN
Northern Mariana Islands	Yes	CN & MN - See territory-specific FN
Ohio	Yes	CN				See service-specific FN
Oklahoma	Yes	CN				See service-specific FN
Oregon	Yes	A - See state-specific FN			Yes	See service-specific FN
Pennsylvania	Yes	CN & MN	$.50-$3/service, depending on payment			See service-specific FN
Puerto Rico	No
Rhode Island	Yes	CN & MN - see state-specific FN			Yes	See service-specific FN
South Carolina	Yes	CN				See service-specific FN
South Dakota	Yes	CN				See service-specific FN
Tennessee	Yes	A & B - See state-specific FN
Texas	Yes	CN & MN			Specified services	See service-specific FN
Utah	Yes	A - See state-specific FN				See service-specific FN
Vermont	Yes	A - See state-specific FN				See service-specific FN
U.S. Virgin Islands	Yes	CN				See service-specific FN
Virginia	Yes	CN & MN			Yes	See service-specific FN
Washington	Yes	CN & MN			Yes	See service-specific FN
West Virginia	Yes	A, B & C		A - 10 one-way trips/year	Yes	See service-specific FN
Wisconsin	Yes	CN & MN	$1/trip in specialized medical vehicle		Trips exceeding 4 weeks	See service-specific FN
Wyoming	Yes	CN				See service-specific FN

2006

Location	Benefit Covered	Coverage Code	Copayment Required?	Limit on services days	Prior Approval Required	Reimbursement Methodology
United States	Yes - 54 No - 2		Yes - 7 No - 47
Alabama	Yes	CN		2 trips/month		See service-specific FN
Alaska	Yes	CN			Yes	See service-specific FN
American Samoa	Yes	See territory-specific FN
Arizona	Yes	CN & MN			Yes	See service-specific FN
Arkansas	Yes	CN & MN				See service-specific FN
California	Yes	CN & MN			Yes	See service-specific FN
Colorado	Yes	CN				See service-specific FN
Connecticut	Yes	CN & MN			Yes	See service-specific FN
Delaware	Yes	CN	$1/trip			See service-specific FN
District of Columbia	Yes	CN & MN			Medi-van transport	See service-specific FN
Florida	Yes	CN & MN	$1/trip	Limited to beneficiaries unable to arrange for medically necessary transportation through any other means	Yes	See service-specific FN
Georgia	Yes	CN & MN	$1/trip			See service-specific FN
Guam	No
Hawaii	Yes	CN & MN				See service-specific FN
Idaho	Yes	CN			Yes	See service-specific FN
Illinois	Yes	CN & MN			All transports other than nursing facility residents	See service-specific FN
Indiana	Yes	CN	$.50-$2/trip, depending on payment	20 one-way trips less than 50 miles/year	Transports greater than 50 miles	See service-specific FN
Iowa	Yes	CN & MN				See service-specific FN
Kansas	Yes	CN & MN			Specified modes of travel	See service-specific FN
Kentucky	Yes	A, B & C - See state-specific FN			Yes	See service-specific FN
Louisiana	Yes	CN & MN			Yes	See service-specific FN
Maine	Yes	CN & MN			Transportation of nursing facility residents	See service-specific FN
Maryland	Yes	CN & MN			Other than public transportation	See service-specific FN
Massachusetts	Yes	CN & MN				See service-specific FN
Michigan	Yes	CN & MN				See service-specific FN
Minnesota	Yes	A - See state-specific FN				See service-specific FN
Mississippi	Yes	CN			Yes	See service-specific FN
Missouri	Yes	CN	$3/day			See service-specific FN
Montana	Yes	A & B - See state-specific FN			Yes	See service-specific FN
Nebraska	Yes	CN & MN			Yes	See service-specific FN
Nevada	Yes	CN			Yes	See service-specific FN
New Hampshire	Yes	CN & MN			Yes	See service-specific FN
New Jersey	Yes	CN & MN			Yes	See service-specific FN
New Mexico	Yes	CN		Transportation to pharmacy for prescription pick-up not covered		See service-specific FN
New York	Yes	CN & MN			Yes	See service-specific FN
North Carolina	Yes	CN & MN				See service-specific FN
North Dakota	Yes	CN & MN				See service-specific FN
Northern Mariana Islands	Yes	CN & MN - See territory-specific FN
Ohio	Yes	CN				See service-specific FN
Oklahoma	Yes	CN				See service-specific FN
Oregon	Yes	A - See state-specific FN			Yes	See service-specific FN
Pennsylvania	Yes	CN & MN	$.50-$3/service, depending on payment			See service-specific FN
Puerto Rico	No
Rhode Island	Yes	CN & MN - see state-specific FN			Yes	See service-specific FN
South Carolina	Yes	CN				See service-specific FN
South Dakota	Yes	CN				See service-specific FN
Tennessee	Yes	A & B - See state-specific FN
Texas	Yes	CN & MN			Specified services	See service-specific FN
Utah	Yes	A - See state-specific FN				See service-specific FN
Vermont	Yes	A - See state-specific FN				See service-specific FN
U.S. Virgin Islands	Yes	CN				See service-specific FN
Virginia	Yes	CN & MN			Yes	See service-specific FN
Washington	Yes	CN & MN			Yes	See service-specific FN
West Virginia	Yes	CN & MN			Yes	See service-specific FN
Wisconsin	Yes	CN & MN	$1/trip in specialized medical vehicle		Trips exceeding 4 weeks	See service-specific FN
Wyoming	Yes	CN				See service-specific FN

2004

Location	Benefit Covered	Coverage Code	Copayment Required?	Limit on services days	Prior Approval Required	Reimbursement Methodology
United States	Yes - 54 No - 2		Yes - 5 No - 49
Alabama	Yes	CN		2 trips/month		See service-specific FN
Alaska	Yes	CN			Yes	See service-specific FN
American Samoa	Yes	See territory-specific FN
Arizona	Yes	CN & MN			Yes	See service-specific FN
Arkansas	Yes	CN & MN				See service-specific FN
California	Yes	CN & MN			Yes	See service-specific FN
Colorado	Yes	CN				See service-specific FN
Connecticut	Yes	CN & MN			Yes	See service-specific FN
Delaware	Yes	CN	$1/trip			See service-specific FN
District of Columbia	Yes	CN & MN			Medi-van transport	See service-specific FN
Florida	Yes	CN & MN	$1/trip	Limited to beneficiaries unable to arrange for medically necessary transportation through any other means	Yes	See service-specific FN
Georgia	Yes	CN & MN	$1/trip			See service-specific FN
Guam	No
Hawaii	Yes	CN & MN				See service-specific FN
Idaho	Yes	CN			Yes	See service-specific FN
Illinois	Yes	CN & MN			All transports other than nursing facility residents	See service-specific FN
Indiana	Yes	CN	$.50-$2/trip, depending on payment	20 one-way trips less than 50 miles/year	Transports greater than 50 miles	See service-specific FN
Iowa	Yes	CN & MN				See service-specific FN
Kansas	Yes	CN & MN			Specified modes of travel	See service-specific FN
Kentucky	Yes	CN & MN			Yes	See service-specific FN
Louisiana	Yes	CN & MN			Yes	See service-specific FN
Maine	Yes	CN & MN			Transportation of nursing facility residents	See service-specific FN
Maryland	Yes	CN & MN			Other than public transportation	See service-specific FN
Massachusetts	Yes	CN & MN				See service-specific FN
Michigan	Yes	CN & MN				See service-specific FN
Minnesota	Yes	A - See state-specific FN				See service-specific FN
Mississippi	Yes	CN			Yes	See service-specific FN
Missouri	Yes	CN				See service-specific FN
Montana	Yes	A & B - See state-specific FN			Yes	See service-specific FN
Nebraska	Yes	CN & MN			Yes	See service-specific FN
Nevada	Yes	CN			Yes	See service-specific FN
New Hampshire	Yes	CN & MN			Yes	See service-specific FN
New Jersey	Yes	CN & MN			Yes	See service-specific FN
New Mexico	Yes	CN		Transportation to pharmacy for prescription pick-up not covered		See service-specific FN
New York	Yes	CN & MN			Yes	See service-specific FN
North Carolina	Yes	CN & MN				See service-specific FN
North Dakota	Yes	CN & MN				See service-specific FN
Northern Mariana Islands	Yes	CN & MN - See territory-specific FN
Ohio	Yes	CN				See service-specific FN
Oklahoma	Yes	CN				See service-specific FN
Oregon	Yes	A - See state-specific FN			Yes	See service-specific FN
Pennsylvania	Yes	CN & MN				See service-specific FN
Puerto Rico	No
Rhode Island	Yes	CN & MN - see state-specific FN			Yes	See service-specific FN
South Carolina	Yes	CN				See service-specific FN
South Dakota	Yes	CN				See service-specific FN
Tennessee	Yes	A & B - See state-specific FN
Texas	Yes	CN & MN			Specified services	See service-specific FN
Utah	Yes	A - See state-specific FN				See service-specific FN
Vermont	Yes	A - See state-specific FN				See service-specific FN
U.S. Virgin Islands	Yes	CN				See service-specific FN
Virginia	Yes	CN & MN			Yes	See service-specific FN
Washington	Yes	CN & MN			Yes	See service-specific FN
West Virginia	Yes	CN & MN			Yes	See service-specific FN
Wisconsin	Yes	CN & MN	$1/trip in specialized medical vehicle		Long trips	See service-specific FN
Wyoming	Yes	CN				See service-specific FN

2003

Location	Benefit Covered	Coverage Code	Copayment Required?	Limit on services days	Prior Approval Required	Reimbursement Methodology
United States	Yes - 54 No - 2		Yes - 4 No - 50
Alabama	Yes	CN		2 trips/month		See service-specific FN
Alaska	Yes	CN				See service-specific FN
American Samoa	Yes	See territory-specific FN
Arizona	Yes	CN & MN			Yes	See service-specific FN
Arkansas	Yes	CN & MN				See service-specific FN
California	Yes	CN & MN			Yes	See service-specific FN
Colorado	Yes	CN			Yes	See service-specific FN
Connecticut	Yes	CN & MN			Yes	See service-specific FN
Delaware	Yes	CN	$1/trip			See service-specific FN
District of Columbia	Yes	CN & MN			Medi-van transport	See service-specific FN
Florida	Yes	CN & MN	$1/trip	Limited to beneficiaries unable to arrange for medically necessary transportation through any other means	Yes	See service-specific FN
Georgia	Yes	CN & MN	$1/trip			See service-specific FN
Guam	No
Hawaii	Yes	CN & MN				See service-specific FN
Idaho	Yes	CN			Yes	See service-specific FN
Illinois	Yes	CN & MN			All transports other than nursing facility residents	See service-specific FN
Indiana	Yes	CN	$.50-$2/trip, depending on payment	20 one-way trips less than 50 miles/year	Transports greater than 50 miles	See service-specific FN
Iowa	Yes	CN & MN				See service-specific FN
Kansas	Yes	CN & MN			Specified modes of travel	See service-specific FN
Kentucky	Yes	CN & MN			Yes	See service-specific FN
Louisiana	Yes	CN & MN			Yes	See service-specific FN
Maine	Yes	CN & MN			Transportation of nursing facility residents	See service-specific FN
Maryland	Yes	CN & MN			Other than public transportation	See service-specific FN
Massachusetts	Yes	CN & MN				See service-specific FN
Michigan	Yes	CN & MN				See service-specific FN
Minnesota	Yes	A - See state-specific FN				See service-specific FN
Mississippi	Yes	CN			Yes	See service-specific FN
Missouri	Yes	CN				See service-specific FN
Montana	Yes	CN & MN			Yes	See service-specific FN
Nebraska	Yes	CN & MN			Yes	See service-specific FN
Nevada	Yes	CN			Yes	See service-specific FN
New Hampshire	Yes	CN & MN			Yes	See service-specific FN
New Jersey	Yes	CN & MN			Yes	See service-specific FN
New Mexico	Yes	CN				See service-specific FN
New York	Yes	CN & MN			Yes	See service-specific FN
North Carolina	Yes	CN & MN				See service-specific FN
North Dakota	Yes	CN & MN				See service-specific FN
Northern Mariana Islands	Yes	CN & MN - See territory-specific FN
Ohio	Yes	CN				See service-specific FN
Oklahoma	Yes	CN				See service-specific FN
Oregon	Yes	CN & MN			Yes	See service-specific FN
Pennsylvania	Yes	CN & MN				See service-specific FN
Puerto Rico	No
Rhode Island	Yes	CN & MN - see state-specific FN			Yes	See service-specific FN
South Carolina	Yes	CN				See service-specific FN
South Dakota	Yes	CN				See service-specific FN
Tennessee	Yes	A & B - See state-specific FN
Texas	Yes	CN & MN			Specified services	See service-specific FN
Utah	Yes	A - See state specific FN				See service-specific FN
Vermont	Yes	A - See state-specific FN				See service-specific FN
U.S. Virgin Islands	Yes	CN				See service-specific FN
Virginia	Yes	CN & MN			Yes	See service-specific FN
Washington	Yes	CN & MN			Yes	See service-specific FN
West Virginia	Yes	CN & MN			Yes	See service-specific FN
Wisconsin	Yes	CN & MN			Long trips	See service-specific FN
Wyoming	Yes	CN				See service-specific FN

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