Covered Services

In order to be approved for Non-Emergency Transportation services, the Participant must be transported to an appointment where they will receive a covered medical service. A covered medical service is a Medicaid Eligible Medical Service (MEMS).

Examples of Covered and non-covered services are:

Covered Services

  • Chemotherapy
  • Radiation
  • Wellness exam, or annual physical exam
  • Glaucoma, Cataracts
  • X-Rays, MRI, CAT scan, or other diagnostic Testing
  • Blood test
  • Hospital admit or discharge
  • Sleep study
  • Outpatient surgery
  • IV infusion
  • Birth control
  • Prenatal care
  • Gastrointestinal problems

Covered Services with Limitations

Emergency room (ER) transports Only approvable if the Participant was referred to the ER by a physician. The referral must be validated before the request can be approved. You will need to provide First Transit with the name and phone number of the referring physician.
Prosthetic device fitting The Participant must be seeing a licensed, certified, health professional; this must be validated by First Transit before the request can be approved.
Prosthetic device pick-up The Participant must be seeing a licensed, certified, health professional and the professional must be performing an adjustment during
the visit; this needs to be validated by First Transit before the request can be approved.
Diabetic teaching; dietician or nutritionist visit Each is allowed once per Participant per lifetime.
Flu shots/vaccinations Must be given by a physician or at a medical facility (not a pharmacy or grocery store) and the Participant must be either a) under 21 years old, b) 22 to 64 years old – only if there is an underlying medical condition which the medical provider believes places the Participant at risk, or c) 65 years old or older
WIC -(Supplemental Program for Women, Infants, & Children) The Participant must be receiving a covered service such as a well child checkup (not just picking up supplies, signing up for benefits, or picking up coupons).
Abortion services Adjudicated on a case-by-case basis.
LTC admit or discharge The Participant cannot be transported out of personal or family choice or convenience. The Request will be evaluated on a case-by-case basis.
Hospital to hospital transports Must be one-way and the Participant must be receiving a Higher Level of Care, that is, inpatient services not available at the originating hospital. Hospital to hospital transports via non-emergency ambulance do not require prior authorization from First Transit. NET Providers may bill HFS directly.
Wheelchair fitting The Participant must be seeing a licensed, certified, health professional; this needs to be validated by First Transit before the
request can be approved.
Wheelchair pickup Approvable ONLY if the wheelchair cannot be delivered and if the Participant is receiving instructions; this must be validated by First
Transit before the request can be approved.
Eye glass fitting and pickup Must be getting an exam or be fitted at time of pickup. For Participants 21 years of age or older the coverage is limited to once every two years.
Group Behavioral Health Services Limited to 2 round trips per week. Not covered for residents 21 years or older residing at a long term care facility.
Tobacco Cessation Counseling Services Covered for:

  • Pregnant and up to 60-day Post-Partum Women age 21 and over for up to a maximum of three quit attempts per calendar year, with up to four individual face-to-face counseling sessions per quit attempt.
  • Children through age 20 with no restrictions.

Non-Covered Services

(Please note, this is not a full list)

  • Massage therapy
  • Prescription pickup
  • Social Security / SSI medical evaluation
  • Wheelchair Repair
  • Smoking cessation for non pregnant women and Participants 21 and older
  • Day care (child or adult)
  • Acupuncture
  • Flu shots or vaccinations at local pharmacies
  • Methadone pickup or treatment
  • Transportation for Emergency services is not covered under NETSPAP. Refer to the handbook for Transportation Services T-200 for emergency transportation procedures.
  • One-way hospital to hospital Transports NOT receiving a Higher Level of Care at the destination hospital
  • Round-trip hospital to hospital transports; the transportation provider must seek payment from the inpatient hospital.
  • ‘No Show’ trips (patient was not transported or was transported but not seen by the medical doctor)
  • Transportation for a Participant who has been declared deceased
  • Medical transportation provided for patients who reside in state-operated facilities; the transportation provider must seek payment from the state-operated facility
  • Artificial insemination
  • Medical or surgical transsexual treatment services
  • Preparation of routine records, forms and reports
  • Services provided only, or primarily, for the convenience of patients or their families
  • Equipment pickup, such as walkers, crutches, bed pans, sick room supplies, etc
  • Pick up for filling prescriptions or any other pharmacy-related item
  • Experimental procedures
  • Infertility/sterility diagnostic or therapeutic proceduresE
  • Early intervention services
  • Sheltered workshops
  • Social rehabilitation programs
  • Day training programs
  • Cosmetic medical treatments
  • Gym
  • Group therapy for Participants 21 years of age or older who reside in a long term care facility