HCPCS code T2004 – Non-emergency commercial carrier pass

Key takeaways

HCPCS code T2004 reports non-emergency transport by commercial carrier on a multi-pass basis, typically a pass that covers several rides.

T2004 is a T-code for state Medicaid agencies, so Medicare does not pay it and there is no national rate.

Each state Medicaid program defines the pass type, the billing unit, and the rate, so check the state provider manual first.

Missing prior authorization and incomplete pass or appointment records are common reasons T2004 claims are denied.

HCPCS code T2004 pays for a carrier pass, not a single trip

HCPCS code T2004 is a Level II code for non-emergency transport by commercial carrier, billed on a multi-pass basis.

The official descriptor reads: Non-emergency transport; commercial carrier, multi-pass. It belongs to the T-code range of the Healthcare Common Procedure Coding System (HCPCS), which was established for state Medicaid agencies.

“Multi-pass” typically refers to a pass that covers several rides on a commercial carrier, such as a bus or transit pass. CMS does not publish a definition of the term. Each state Medicaid program decides what a pass covers, what one unit means, and how the code is billed.

The closest neighbor is T2003, the general code for Non-emergency transportation; encounter/trip. The difference lies in how the service is bought. T2004 is a pass, and T2003 is one trip. Neither descriptor refers to the number of people riding in the vehicle.

Three terms in the descriptor shape every T2004 claim

Each term in the descriptor narrows what T2004 can be used for. Here’s what each one means day to day, and how it changes the claim.

T2004 covers carrier passes, not taxis or stretcher vans

T2004 has a narrow scope, and a claim outside it is likely to be denied. Use the two lists below as a quick scope check.

Typically covered under T2004:

• A multi-ride pass on a commercial carrier, such as a bus or transit pass, issued so a Medicaid beneficiary can reach covered medical appointments
• Passes arranged by the Medicaid agency, a managed care plan, or a non-emergency medical transportation (NEMT) broker, if the state plan assigns them to T2004

Not covered under T2004:

• Individual trips billed per encounter, which are typically reported with T2003
• Emergency or urgent transport that requires ambulance services
• Stretcher van transport, which has its own code (T2005)
• Patient attendant or escort services, which are reported with T2001
• Volunteer or private-vehicle mileage, which states bill under other codes such as S0215 or A0080
• Transport to appointments or services that the state Medicaid plan does not cover

Taxi rides deserve their own check. They have a separate code, A0100, so a cab voucher generally belongs on a different claim line.

Neighboring T-codes cover escorts, single trips, and stretcher vans

The T2001-T2007 range splits non-emergency transport by service type. The table maps the closest codes to their official descriptors, and our HCPCS code library lists the full set.

Pick the code that matches how the state purchased the service. A pass bought for a beneficiary is usually T2004, and an individual trip is usually T2003. If your state manual assigns transit passes to a different code, follow the manual.

Medicaid pays for T2004, and most programs want approval first

T2004 is a Medicaid code. T-codes were established for state Medicaid agencies, and Medicare does not pay them. Medicare Advantage plans may offer transportation as a supplemental benefit, but each plan sets its own terms.

States run the NEMT benefit in one of two ways. The Medicaid agency may run it directly, or it may contract a managed care organization (MCO) or NEMT broker. Where a broker runs it, the broker approves requests and picks the mode of transport. That choice decides whether a pass or a single trip gets billed.

Prior authorization: Most state Medicaid programs and MCOs require prior authorization (PA) for NEMT services, including T2004. Requirements commonly include:

• A request submitted within the state’s advance-notice window, which varies by program
• Medical necessity documentation showing why the beneficiary needs transportation assistance
• Appointment confirmation from the healthcare provider, including address, date, and time
• The pass type and period the program will fund, where the state sets them

A pass or trip provided without an approved PA is a frequent cause of T2004 denials. If approval came too late, check whether your state accepts a post-service request. Then document why the travel could not wait. Our walkthrough of the prior authorization process covers request timing in more depth.

Six records every T2004 claim needs on file

Medicaid programs and NEMT brokers want proof that a pass was issued for covered medical travel. Keep these six records on file, ready for an audit request:

• Pass record: The pass type, the period or number of rides it covers, its cost, and the date it was issued to the beneficiary
• Beneficiary eligibility: The beneficiary’s name, Medicaid ID number, and active enrollment on the date of service
• Appointment confirmation: Written or electronic confirmation from the receiving provider of the covered appointments the pass supports
• Carrier details: The name of the commercial carrier, such as the transit authority or bus line, and any state-required provider enrollment
• Prior authorization number: The PA reference must appear on the claim wherever the state requires one
• Usage records: Some states ask for proof of the trips the pass was used for, so confirm what your program expects

Keep these records for the retention period your state Medicaid program sets. Store them with the claim, so an auditor can match each pass to its authorization and appointments.

Units, claim fields, and modifiers follow your state’s rules

Three parts of a T2004 claim depend on state rules: the unit, the CMS-1500 fields, and any modifiers. Check each one against your Medicaid provider manual before you submit.

Units: Each state defines what one unit of T2004 represents, and the pass type it applies to. Confirm the unit definition in the state fee schedule or provider manual before you set up a billing template. A unit mismatch leads to underpayment, or to an overpayment finding on audit.

CMS-1500 fields: Report T2004 in Box 24D and the date of service in Box 24A. Box 24B takes the place of service code your state’s NEMT rules require, commonly 99 for other place of service. The PA number goes in Box 23. The rendering provider or transport company NPI goes in Box 24J.

State manuals decide which modifiers T2004 needs

Modifier rules for T2004 are set by each Medicaid program or MCO. The table covers modifiers that state manuals sometimes require. Verify each one against your state’s NEMT provider manual before you apply it.

State-assigned U-series modifiers vary the most. What U3 means in one state’s NEMT program may differ entirely in another, so never assume a modifier definition carries across state lines.

Follow one transit pass from request to payment

Clean T2004 billing starts well before the claim. Records that are missing at billing time are hard to rebuild later. The flow below shows each step, and the point where it most often stalls.

Take an illustrative case. A Medicaid patient needs rides to physical therapy twice a week for a month. The NEMT broker approves a transit pass instead of individual trips. Here’s how that pass becomes a paid claim:

1. Eligibility check. Confirm the patient’s active Medicaid enrollment for the date of service. Then check that NEMT is a plan benefit and the therapy visits are covered.
2. Prior authorization. Send the PA request to the program or broker inside the notice window. Record the PA number before the pass is issued.
3. Pass issue and record. Note the pass type, the rides or period it covers, its cost, and the issue date. Link it to the therapy appointments it supports.
4. Claim generation. Put T2004 in Box 24D and the PA number in Box 23. Add the date of service, the state’s unit count, and any required modifiers.
5. Remittance review. Once payment posts, check for partial adjustments or denials. Log each T2004 denial reason, so patterns show up over time.

If the claim comes back short, the electronic remittance advice carries the adjustment codes that explain why. Start any fix there.

Run this six-point check before you submit

A quick check before each T2004 claim leaves the office catches the most common errors. Confirm that:

• Medicaid enrollment was active on the date of service
• The PA number is recorded and entered in Box 23
• The unit count matches your state’s definition for T2004
• Any modifiers match the state NEMT provider manual
• The pass record and appointment confirmations are on file
• The claim is going to Medicaid, the MCO, or the broker, not Medicare

No national rate exists, so check your state’s fee schedule

T2004 has no national CMS reimbursement rate. HCPCS T-codes are paid under state Medicaid fee schedules, and each state sets its own rates. The rate may also depend on the pass type and the unit the state defines.

To find your rate, search the Medicaid agency’s published fee schedule or the NEMT broker’s contracted rate schedule. State portals, such as Wisconsin’s ForwardHealth portal, publish updated fee schedules. Rates also differ when a managed care plan pays instead of the state paying fee-for-service.

Don’t use another state’s published rate as a proxy. Rates for the same T-code can differ widely between states. Billing against a neighboring state’s schedule leads to underpayment disputes.

Six common T2004 denials and how to fix each one

T2004 denials tend to come from a short list of problems. Fix each one at its source rather than claim by claim, and repeat denials drop across your Medicaid claims.

How to appeal a denied T2004 claim in five steps

Medicaid appeal windows vary by state, typically from 30 to 90 days after the date of the remittance advice (RA). Verify the window in your state’s provider manual before the deadline passes.

1. Pull the RA and identify the denial code. The Claim Adjustment Reason Code (CARC) tells you why the claim was denied. Match it to the corrective action in the table above before you draft the appeal.
2. Gather supporting documentation. For T2004, this means the pass record, appointment confirmations, the PA approval number, and the carrier details. A missing item weakens the appeal.
3. Submit a corrected claim or a formal appeal. Some denials, such as a wrong unit count or missing modifier, are fixed by voiding the original and resubmitting. Medical necessity and PA disputes need a formal written appeal to the state agency or MCO.
4. Follow up within the payer’s review period. If no decision arrives in time, contact the state agency or the broker’s provider relations line for a status update.
5. Escalate if the appeal fails. Beneficiaries have a right to a Medicaid fair hearing, and state rules set the review routes open to providers.

How Pabau keeps Medicaid appointments and claims in step

Pabau, the practice management platform we build for healthcare practices, does not dispatch vehicles or manage transit passes. It helps when your practice books Medicaid patients who rely on NEMT, or bills Medicaid claims of its own.

Each appointment record holds the date, time, and address that brokers ask for in a confirmation. Through Pabau’s claims management software, the CMS-1500 is pre-filled from the patient record. Required fields, such as authorization numbers, are checked before a claim can be sent.

US claims go through Claim.MD, with eligibility checks, ERA posting, and claim-status tracking built in. Fewer claims come back for missing data, so your team spends less time on rework.

Send Medicaid claims with fewer missing fields

Pabau pre-fills claims from the patient record and checks required fields, such as authorization numbers, before submission. Your team spends less time fixing rejected claims.

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Conclusion

T2004 rewards billers who read the state manual first. CMS defines the code in one line and leaves the details to each Medicaid program. Your state’s provider manual is the working definition.

The effort is front-loaded. Confirm the pass type and unit, secure the PA number, and tie the pass to covered appointments before anyone files. Do that, and the usual denial triggers are handled before the claim exists.

Book a demo to see how Pabau keeps appointment records and claim fields in step for your Medicaid billing.

Continue your research

Need to understand how NEMT claims flow through a clearinghouse? Medical claims clearinghouse guide explains how electronic claims are validated and routed to Medicaid payers.

Billing individual trips rather than passes? HCPCS code T2003 covers the general per-trip code for non-emergency transportation.

Want to catch enrollment problems before the pass is issued? Insurance eligibility verification shows how to check coverage before every visit.

Seeing the same T2004 denials month after month? Denial management in healthcare breaks down the causes of denials and how to prevent repeats.

Worried about missing a resubmission deadline? Timely filing limits by payer lists the windows for initial claims, corrected claims, and appeals.

Frequently asked questions