How to Get Prior Authorization for Insurance-Covered Stretcher Transport

If you or a loved one needs stretcher or gurney transport to medical appointments, your insurance may cover it. This guide walks you through the entire Prior Authorization process — from getting your doctor's certification to scheduling your covered ride with Dream Care Rides.

What Is Prior Authorization for Stretcher Transport?

Prior Authorization (PA) is pre-approval from your insurance company confirming that a medical service — in this case, non-emergency stretcher transport — is medically necessary and will be covered under your plan.

Insurance companies require PA for stretcher transport because it is a higher-cost service than wheelchair or sedan transport. The PA process ensures that:

The patient genuinely cannot be transported in a seated position
A physician has certified the medical necessity
The transport is to or from a covered medical appointment
The provider (Dream Care Rides) is an enrolled, credentialed transporter

Without a valid PA, your insurance will not pay for stretcher transport. However, the process is straightforward and your doctor's office, hospital, or facility can often handle much of it for you.

Who Qualifies for Insurance-Covered Stretcher Transport?

Stretcher transport is medically appropriate for patients who cannot safely sit upright in a wheelchair or sedan during transit. Common qualifying conditions include:

Post-surgical patients — Hip replacement, spinal surgery, or major abdominal procedures requiring supine positioning
Spinal conditions — Herniated discs, spinal fractures, or severe sciatica preventing seated posture
Hip and femur fractures — Patients with non-weight-bearing restrictions
Bed-bound or immobile patients — Those who cannot transfer from bed to wheelchair independently
Severe obesity (bariatric) — Patients over 300 lbs who cannot safely use a standard wheelchair van
Advanced neurological conditions — Paraplegia, quadriplegia, advanced MS, or ALS
Wound care patients — Large wounds, pressure ulcers, or surgical sites requiring supine positioning
End-of-life or hospice patients — Transport to appointments, family visits, or between facilities

Need Stretcher Transport Now?

If you already have your Prior Authorization, call us to schedule your ride. We bill your insurance directly.

Call (866) 507-5724 (708) 505-6994

The Physician Certification Statement (PCS) Explained

The PCS is the single most important document in the prior authorization process. It is a written statement from a licensed physician (MD, DO, NP, PA, or CNS) certifying that the patient requires stretcher transport for medical reasons.

What the PCS Must Include

Patient demographics — Full name, date of birth, insurance member ID number
Medical diagnosis — ICD-10 codes supporting the need for stretcher transport
Clinical justification — Specific explanation of why the patient cannot sit upright in a wheelchair or sedan
Mobility assessment — Current functional status, weight-bearing limitations, and transfer ability
Transport details — Origin and destination addresses, facility names, appointment information
Frequency and duration — For recurring trips (e.g., dialysis 3x/week for 6 months), the schedule must be specified
Physician signature — Must be signed before the first transport date

PCS Validity Period

A PCS can be valid for up to 12 months from the date of the physician's signature for recurring transport. For one-time trips, the certification must be dated no more than 60 days prior to the date of service.

Medical Necessity Criteria for Stretcher Transport

Insurance companies evaluate medical necessity based on specific criteria. To be approved for stretcher transport, at least one of the following must be documented:

Patient is unable to sit upright for the duration of transport due to a medical condition
Patient is unable to safely transfer from bed to wheelchair without risk of injury
Patient has non-weight-bearing restrictions that prevent wheelchair use
Patient requires supine (lying flat) positioning during transport for medical reasons
Patient's weight exceeds wheelchair van capacity (typically 300+ lbs) and requires bariatric stretcher transport
Patient has medical equipment (traction, IV lines, wound drainage) requiring stretcher positioning

Important: Simply preferring to lie down or being "more comfortable" on a stretcher is generally not sufficient for medical necessity. The PCS must document a specific medical reason.

Healthcare Facility? Partner With Us

We work with hospitals, SNFs, and clinics to streamline stretcher transport billing. Let us handle the transportation so you can focus on patient care.

Facility Partnership (708) 505-6994

Step-by-Step Prior Authorization Process

Step 1: Confirm Your Insurance Covers Stretcher Transport

Call the member services number on the back of your insurance card. Ask specifically:

"Does my plan cover non-emergency stretcher van transport?"
"What is the HCPCS code for stretcher van transport under my plan?" (Usually T2005 for Medicaid, A0428 for Medicare)
"Is prior authorization required, and what is the PA process?"
"Who should the PCS be submitted to — the plan directly or a transportation broker?"

Step 2: Obtain the Physician Certification Statement

Schedule an appointment with your treating physician or ask your hospital's discharge planner to coordinate the PCS. Bring your insurance card and appointment details. The physician will document your medical condition and certify the need for stretcher transport.

Step 3: Submit the PCS for Authorization

Depending on your plan, submit the PCS to one of the following:

Medicaid MCOs (IL) — Submit to the plan's transportation broker (e.g., MTM for Meridian/Molina)
Indiana Medicaid FFS — Submit to the IHCP FFS PA-UM contractor (stretcher transport is exempt from brokerage in IN)
Medicare Advantage — Submit to the plan's prior authorization department or designated broker

Processing typically takes 3-5 business days for routine requests. Urgent requests can be expedited to 24-72 hours.

Step 4: Schedule Your Ride With Dream Care Rides

Once you receive your PA approval number, call us at (866) 507-5724 with:

Your PA / Authorization number
Insurance member ID
Pickup and destination addresses
Appointment date, time, and expected duration
Any special needs (oxygen, bariatric, Broda Traversa)

We handle dispatching, transport, and direct billing to your insurance. You receive confirmation with driver details and real-time tracking updates.

Insurance Plans That Cover Stretcher Transport

Illinois Medicaid Managed Care

These Illinois Medicaid MCOs cover stretcher van transport (HCPCS T2005) with a valid PCS and prior authorization:

Molina Healthcare of Illinois — PA through MTM: (866) 941-5764
Meridian Health Plan — PA through MTM: (866) 606-3700
Blue Cross Community Health Plan — (877) 860-2837
Aetna Better Health of Illinois — (866) 329-4701
CountyCare Health Plan (Cook County) — (312) 864-8200

Indiana Medicaid

Indiana Medicaid covers stretcher transport through these managed care entities. Important: Since July 1, 2023, stretcher transport is exempt from brokerage for Indiana Medicaid FFS members — you can schedule directly with us.

Anthem BCBS (HHW, HIP, HCC) — (866) 408-6131
CareSource (HHW, HIP, HCC) — (844) 607-2829
MHS (HHW, HIP, HCC) — (877) 647-4848
MDwise (HHW, HIP) — (800) 356-1204
Humana Healthy Horizons (PathWays for Aging) — (800) 787-3311

Medicare Advantage & D-SNP Plans

Stretcher transport coverage under Medicare Advantage varies significantly by plan. D-SNP (Dual Special Needs Plans) are the most likely to include stretcher benefits:

Humana D-SNP — Via SafeRide Health: (866) 588-5122
Aetna / CVS Health D-SNP — Via MTM Health: (888) 632-3862
Centene / WellCare D-SNP — Via Modivcare: (866) 386-8331
UnitedHealthcare — Check your specific plan Evidence of Coverage: (877) 842-3210

View Our Complete List of Accepted Plans

See every insurance plan we bill directly, with phone numbers, broker contacts, and PA instructions.

Accepted Insurance Plans (708) 505-6994

HCPCS Billing Codes for Stretcher Transport

Understanding billing codes helps you communicate effectively with your insurance company. Here are the key codes used for stretcher transport:

Primary Stretcher Transport Codes

T2005 — Non-emergency transportation; stretcher van. The primary Medicaid billing code for stretcher van (non-ambulance) transport.
T2049 — Stretcher van mileage (per loaded mile). Add-on code billed per mile from pickup to destination.
A0428 — BLS non-emergency transport. Used for Medicare and commercial plans when BLS ambulance is the transport vehicle.

Additional Codes

T2001 — Patient attendant/escort services during transport
T2003 — Non-emergency transportation encounter/trip (base code)
A0130 — Wheelchair van transport (comparison code for when wheelchair transport is an alternative)

Common Modifiers

UJ — Night transport (7 PM - 7 AM)
TK — Extra patient/passenger
QN — Transport furnished directly by provider (Dream Care Rides bills directly)

Illinois-Specific Requirements

Illinois has specific requirements for stretcher van providers and transport authorization:

Provider Licensing

Dream Care Rides is licensed under 77 Ill. Admin. Code 515.835 and 515.840 (IDPH Stretcher Van Provider Licensing) and 210 ILCS 50/3.86. All vehicles are registered with the Illinois Department of Public Health.

Medicaid Enrollment

We are enrolled in the Illinois IMPACT system as an "Atypical Agency" stretcher van provider. All vehicle identification numbers and license plates are on file with the state.

MCO-Specific Processes

Managed care members contact their MCO directly (number on membership card) for PA
Fee-for-service members — Transdev Inc. adjudicates PA requests for FFS NEMT
Base rate reimbursement is determined by the county in which the provider is based
Mileage is bundled in the base rate for Medicaid (separate for Medicare)

Indiana-Specific Requirements

Indiana has a unique exemption that makes stretcher transport significantly easier to access:

Stretcher Transport Brokerage Exemption

Since July 1, 2023, stretcher transport is exempt from brokerage under Indiana Medicaid. This means:

Fee-for-service members do not need to go through the Verida NEMT broker for stretcher transport
Stretcher rides should be scheduled directly with an IHCP-enrolled provider (like Dream Care Rides)
For managed care members, contact your specific MCE for their stretcher transport process

Provider Enrollment

Dream Care Rides is enrolled as IHCP Provider Type 26 (Transportation Provider) in Indiana. We bill directly for stretcher transport services.

Indiana Medicaid Programs

Stretcher transport is available under these Indiana Medicaid programs:

Hoosier Healthwise (HHW) — For families and children
Healthy Indiana Plan (HIP) — For adults 19-64
Hoosier Care Connect (HCC) — For aged, blind, and disabled
PathWays for Aging — For dual-eligible seniors

Discharge Planners & Case Managers

We make it easy for facilities to arrange covered stretcher transport. Dedicated account team, direct billing, and real-time status updates.

Facility Partnership (708) 505-6994

Tips for Faster PA Approval

Based on our experience billing thousands of stretcher trips, here are the most effective ways to speed up your PA approval:

Be specific on the PCS. Vague language like "patient needs stretcher" gets denied. Instead: "Patient cannot maintain seated posture due to recent L4-L5 laminectomy with non-weight-bearing restrictions for 6 weeks."
Include recent medical records. Attach the most recent progress notes, operative reports, or discharge summaries supporting the medical condition.
Use the correct ICD-10 codes. Match the diagnosis codes on the PCS to the condition requiring stretcher transport. Generic codes weaken the justification.
Submit to the right entity. Know whether your plan handles PA internally or routes through a broker (MTM, Modivcare, SafeRide). Submitting to the wrong place causes delays.
Request expedited review when appropriate. For hospital discharges or urgent medical appointments, request expedited/urgent PA processing (24-72 hours instead of 3-5 days).
Follow up proactively. Call the PA department 2-3 business days after submission to check status. Ask for a reference number when you submit.
Plan ahead for recurring transport. If you need ongoing stretcher transport (dialysis, wound care), request a PCS covering the full treatment schedule. One PA for 12 months is far easier than monthly renewals.

Frequently Asked Questions

A stretcher van (billed under HCPCS T2005) provides non-emergency transport for patients who need to lie flat but do not require medical monitoring or paramedic services en route. An ambulance (A0428 BLS) provides medical personnel and monitoring capability. Stretcher vans are significantly less expensive and appropriate when the patient is medically stable but cannot sit upright.

Yes. Most insurance plans accept faxed PCS forms. Your doctor's office can fax the completed PCS to your plan's prior authorization department or their designated transportation broker (e.g., MTM, Modivcare, SafeRide Health). Ask your insurance for their fax number when you call to initiate the PA request.

For one-time trips, the PA is typically valid for 30-60 days from the approval date. For recurring transport (like dialysis 3x/week), a PA can be valid for up to 12 months. The PCS from your doctor must specify the frequency and duration of transport needed.

You have the right to appeal any PA denial. Common reasons for denial include insufficient documentation of medical necessity, missing physician signature, or the plan determining that a lower level of transport (wheelchair) is appropriate. Your doctor can submit additional documentation supporting the need for stretcher transport. You can also book as a private pay patient while the appeal is processed.

No. For recurring medical appointments (dialysis, radiation therapy, wound care), a single PCS can cover all trips for the authorized period (up to 12 months). However, if your medical condition changes or you need transport to a new destination, an updated PCS may be required.

Common ICD-10 codes include: M54.5 (low back pain with immobility), S72 (hip fracture), Z96.64 (hip joint replacement), G82 (paraplegia), R26.0 (ataxic gait), Z74.01 (bed confinement status), and post-surgical codes. Your doctor will determine the appropriate diagnosis codes based on your specific condition.

Yes. Hospital discharge planners, social workers, and case managers routinely submit PA requests for medical transportation. They can also complete the PCS request with your treating physician and coordinate scheduling with Dream Care Rides once the PA is approved.

Yes. We work with transportation brokers including MTM, Modivcare, and SafeRide Health. If your insurance plan routes stretcher transport through a broker, we can accept trips authorized through their system. Contact us to confirm we are credentialed with your specific broker.

Most insurance plans offer expedited/urgent PA processing within 24-72 hours for medically urgent situations (e.g., hospital discharge, emergency follow-up). Ask your plan about their expedited review process. Alternatively, you can book as a private pay patient immediately and submit for reimbursement later, or we can help you explore retroactive authorization options.

For Medicaid members, stretcher transport with valid PA typically has no out-of-pocket cost. For Medicare Advantage members, costs depend on your specific plan's copay and coinsurance structure. Some D-SNP plans cover NEMT at no cost. Call your plan's member services to confirm your specific cost-sharing responsibility.