Pre-Authorization for Ambulance Transport in Georgia.

Make sure your transport is approved in advance. Use the form below to request authorization for non-emergency ambulance services.

Submitting a Medicaid Pre-Authorization in Georgia

Non-emergency ambulance transports under Georgia Medicaid often require pre-authorization. Submit claims using the CMS-1500 form with documentation that supports medical need.

To prepare your request:

Use the correct HCPCS billing codes.

For base rates, use A0428 (BLS), A0426 (ALS), and A0434 (CCT).

For mileage, use A0425—billed as one unit per mile.

Attach Trip Details

Include a report showing the trip’s purpose, pickup and drop-off locations, patient status, and level of care provided. If it’s a round trip, it should be counted as two units

Ensure all documents are submitted.

Missing documentation, especially the run report, may result in claim denial.

Submit Prior Authorization.

Please complete and submit the Prior Authorization Ambulance Form with all required patient and insurance information. Our team will process your request promptly.