`A0200` Noner transport lodgng escrt

Non-emergency transportation: ancillary: lodging escort

Medicare coverage: Not payable by Medicare
Status: active (October 2026 file)

Medically Unlikely Edits (effective October 1, 2026)

Practitioner: max 0 units per day (clinical), rationale: CMS Policy
Outpatient hospital: max 0 units per day (clinical), rationale: CMS Policy

Medicare pricing for A0200

Physician Fee Schedule (CY 2026, RVU26D)

Status I: not valid for Medicare (Medicare uses another code).

Payer policies and prior authorization for A0200

Payer coverage policies that name A0200

A0200 appears in 4 coverage policies from Blue Cross & Blue Shield of Mississippi, Blue Cross & Blue Shield of Rhode Island, Health Care Service Corporation (BCBS IL, TX, OK, NM, MT), Premera Blue Cross.

Payer	Policy	Role in policy	Reviewed	Document
Blue Cross & Blue Shield of Mississippi	Ambulance And Medical Transport Services (L.9.01.400)	covered if criteria are met		payer document
Blue Cross & Blue Shield of Rhode Island	Ambulance Services - Ground MEDICAL COVERAGE POLICY \| 3	not covered	Sep 17, 2025	payer document
Health Care Service Corporation (BCBS IL, TX, OK, NM, MT)	Ambulance and Transport Services (MED201.058) HCPCS Codes A0021, A0080, A0090, A0100, A0110, A0120, A0130, A0140, A0160,	listed, no stance	Jun 15, 2026	payer document
Premera Blue Cross	Non-covered Services and Procedures	listed, no stance	Jun 1, 2026	payer document

Medicaid fee-for-service

Prior authorization required or conditional in IN.

KS: $54.00 (default), effective Nov 1, 2009
VA: $1.00 (medical), effective Apr 1, 2008
VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026
WY: $0.00 (outpatient_hospital_apc, Children's Hospitals), effective Apr 1, 2026

From payers' published prior-auth lists, coverage policies and state Medicaid fee schedules, updated Oct 16, 2026. The role is what the policy's own code table or text says about the code. Not a guarantee of coverage or payment; verify with the payer. CPT® is a registered trademark of the American Medical Association.

A0200 Noner transport lodgng escrt