A0190 Billing Code: Rider Meals on Long Medical Trips, Units, Rates, and Approval

What A0190 means

CMS lists A0190 in the national HCPCS code set as “Non-emergency transportation: ancillary: meals-recipient.” The recipient is the Medicaid member who rides. The October 2026 quarterly file shows the code was added on January 1, 1984. It carries coverage code I, which means Medicare does not pay it, and pricing indicator 00, which means Part B sets no price.

A0190 is an add-on line for a long trip, never a charge for the ride. It sits with three related codes:

Code	What it pays for
A0180	Lodging for the rider
A0190	Meals for the rider
A0200	Lodging for an escort
A0210	Meals for an escort

The federal basis is 42 CFR 440.170(a)(3), which counts “the cost of meals and lodging en route to and from medical care, and while receiving medical care” as a travel expense. CMS’s Medicaid Transportation Coverage Guide (SMD 23-006, September 28, 2023) says coverage of these related travel expenses, when necessary to reach covered care, is required. The national code sets no unit, so each state defines one. See NEMT billing codes for the full list.

What one unit of A0190 covers

Where a state pays a meal allowance without naming a code, the table shows the allowance.

Program	Unit	Rate	Effective
New Mexico	One meal	$7.64	January 1, 2025
Alaska	Three consecutive meals per person, for each night of lodging	Actual food purchased, up to $36	July 1, 2026 to June 30, 2027
North Dakota	A full day of meals	$32.46	July 1, 2026
Colorado	Per diem	$43.96 (it was $44.86 from October 1, 2025)	July 1, 2026
Louisiana	Per diem	No more than the GSA per diem for the location. GSA’s standard meals and incidental expenses rate is $68 for travel from October 1, 2026 to September 30, 2027, with higher tiers up to $92.	Rate policy effective October 1, 2015, on the schedule updated September 2025
Iowa	Actual cost	No more than the subsistence allowance for state employees under rule 11-41.6(8A), with detailed receipts	Rule effective July 1, 2026
South Dakota	Per day of an overnight stay, with no code on the schedule	$40 for meals without lodging, $150 for meals with lodging, plus $40 a day for a medically necessary escort unless the member is an inpatient. Paid only when care is at least 150 miles from the member’s city.	August 1 and November 1, 2024
Alabama	Per person per day	Up to $50 for meals and lodging together, with receipts or confirmation of the expense	March 16, 2024

North Dakota also bills single meals with three codes of its own: A0191 for breakfast at $6.49, A0192 for lunch at $9.74, and A0193 for dinner at $16.23, as of July 1, 2026. They are not national HCPCS codes, and the October 2026 CMS file has no A0191 to A0193. Use them only on North Dakota claims.

Worked example. A rider eats breakfast, lunch, and dinner on an approved trip day.

Program	Math	Most it pays
New Mexico	3 meals x $7.64	$22.92
North Dakota	$6.49 + $9.74 + $16.23, the same as one A0190 day	$32.46
Alaska	One unit, at the actual cost of the food	Up to $36.00
Colorado	One per diem	$43.96

In Alaska, if the three meals cost more than $36, the rider pays the difference.

What approval states require before a meal claim

Each program sets its own time or distance test and its own approval step:

Program	When meals are covered	Approval before the trip
North Dakota	Only when care or travel arrangements require an overnight stay	Overnight travel must be pre-approved, and the human services zone or tribe approves the trip on form SFN 1507. Care more than 50 miles past the state border also needs ND Medicaid service authorization. (Manual updated January 2026)
Alaska	Outpatient treatment that requires an overnight stay outside the home community, with meals from the enrolled hotel or motel restaurant	Service authorization. The AK-04 Transportation Authorization and Invoice lists the approved units.
New Mexico	The member leaves the home community for 8 hours or more for medical or behavioral health care	The physician attests in writing to the need for care outside the community. Authorization forms come from the local county Income Support Division (ISD) office, and out-of-state stays are approved up to 30 days at a time.
Iowa	The trip spans the entire meal period, the appointment is more than 50 miles away one way, and the meal is necessary	The claim goes to the broker within 120 days of the trip, with detailed receipts.
Indiana	Extended treatment that requires at least one overnight stay, for the member and one escort	The state Medicaid agency, FSSA, preapproves every request. The broker may apply the Indiana State Travel Policy limits and pays from its capitation payment. (Module published August 19, 2025)
Louisiana	Travel time plus the appointment totals more than 12 hours	The broker approves and pays. A denial must be in writing and explain the right to a fair hearing. (Manual section issued July 14, 2025)
Texas fee-for-service	Clients from birth through age 20 and their guardian or responsible adult	The Medical Transportation Program prior authorizes all fee-for-service services (September 2026 handbook).
Alabama	Overnight travel is necessary	Receipts or confirmation of the expense before payment
Illinois fee-for-service	Not paid on transportation claims	The transportation handbook lists meals among the charges the state does not pay (March 11, 2024).

For how approvals work in general, see prior authorization. For the long trips that lead to meal claims, see rural NEMT.

What a meal claim cannot include

Alaska’s transportation and accommodation manual gives the most detailed list. It does not pay for:

• Alcoholic drinks, tips, room service, or meals for guests.
• Meals beyond those authorized, or meals at restaurants not enrolled with Alaska Medicaid.
• Meals while the member is admitted as an inpatient.
• Meals for a child under 2. The escort’s meals are covered instead, and the escort is expected to share with the child.

North Dakota also does not pay a driver’s or attendant’s meals while the member is a patient in a medical facility, unless it costs less for them to stay in the area.

How to claim A0190 step by step

1. Get the trip approved first. Ask the state program or broker before the ride, and keep the approval number or form.
2. Check the state’s meal test. Hours away, distance, meal periods, or an overnight stay decide whether a meal counts.
3. Keep itemized receipts. Iowa wants detailed receipts, Alabama wants receipts or confirmation, and Alaska pays the actual cost of the food.
4. Bill the right code for who ate. Use A0190 for the rider and A0210 for an escort. Alaska wants rider and escort meals on the same AK-04.
5. Count units the way your state does. One meal in New Mexico, three meals in Alaska, a day in North Dakota and Colorado.
6. Send the claim through the right channel. North Dakota meal providers bill through the North Dakota Web Portal’s Travel, Meals, and Lodging claim page, or on the professional claim if they have an NPI. Alaska accepts only original AK-04 forms, uses diagnosis code Z75.3 on electronic claims, and rejects photocopies and faxes.