TN Modifier: The Rural Trip Modifier on NEMT Claims

What the TN modifier means

CMS lists TN in the national HCPCS code set as “Rural/outside providers’ customary service area.” It entered the code set on April 1, 2002, and the October 2026 quarterly file gives it coverage code I, which means Medicare does not pay it.

A modifier is a two-character tag after a billing code. It changes what the line pays for without changing the code. TN goes on a base code, such as A0130 for a wheelchair van trip, or on a mileage code, to say the trip was rural. It sits in box 24D of the CMS-1500 with any other modifiers, such as the U modifiers some states use for service levels or the origin and destination modifiers.

The code set gives TN no map. Each program that uses it draws its own line:

• A metro area. Arizona counts any trip that starts outside the Phoenix and Tucson metro areas as rural.
• City limits. South Dakota uses TN for community trips outside city limits.
• A Census line. Alaska counts a pickup as rural when it sits outside an area the Census Bureau delineates as urbanized.

For the related idea of where you choose to drive, see service area.

Which programs pay more with TN

Arizona, South Dakota, and Alaska Medicaid publish TN rates for non-ambulance trips. Each one uses TN to pay a higher rural rate, but each draws the line differently and puts TN on different codes.

Program	When TN applies	What TN pays
Arizona AHCCCS fee-for-service (effective October 1, 2026)	Every trip that starts outside the Phoenix and Tucson metro areas, on every ground NEMT code	More on six codes, such as $86.70 instead of $49.09 for a stretcher van trip. The rest pay the same.
South Dakota Medicaid (effective July 1, 2026)	Community transportation trips outside city limits, on A0120	150 percent of the fee: $7.80 instead of $5.20 a one-way trip
Alaska Medicaid (July 1, 2026 to June 30, 2027)	Wheelchair van trips from a rural pickup, and ambulance codes	$35.00 plus $0.69 a mile, where an urban wheelchair van trip pays $35 with no mileage

Arizona: TN on every trip outside Phoenix and Tucson

Chapter 14 of the AHCCCS fee-for-service billing manual (revised July 31, 2026) sets separate urban and rural rates for certain non-ambulance services. Urban transports are those that originate within the Phoenix and Tucson metropolitan areas. All others are rural and “must be billed with the ‘TN’ modifier.” AHCCCS says the rural rate is meant for atypical conditions: unmaintained or dirt roads, long distances to reach the member, and few providers in the area.

The schedule effective October 1, 2026 lists a TN line for every ground NEMT code. Six pay more with TN: the mini-bus base (A0120), the wheelchair van base (A0130), the stretcher van base (T2005), and the three mileage codes, S0209, S0215, and T2049. The volunteer, family, caseworker, and taxi codes and waiting time pay the same either way, but the schedule still lists a TN line for each. S0215 with TN rose to $1.63 a mile on October 1, 2026, from $1.53 in the schedule effective October 1, 2025, and no other ground NEMT rate changed (the full story). Every urban and rural amount is in the Arizona guide.

TN matters most on stretcher trips. Example: a stretcher van takes a member from home to a clinic and back on one day, 16 loaded miles in all, and both trips start outside the Phoenix and Tucson metro areas. AHCCCS wants every trip for the member that day on one claim: the trips on line 1, the loaded miles on line 2, and any wait time on line 3.

Line	Code	Units	Amount
1	T2005 TN	2 trips	2 x $86.70 = $173.40
2	T2049 TN	16 miles	16 x $1.66 = $26.56
Total			$199.96

The same day billed without TN pays $122.82, at $49.09 a trip and $1.54 a mile. Leaving TN off a rural day costs you $77.14 here, and billing it on a metro day bills a rate you are not owed.

Two cautions. The NEMT claim allows only those three lines, and any extra line denies. So if one trip of a day starts inside the metro areas and another starts outside them, ask AHCCCS how to bill that day before you submit it. And these rates are for fee-for-service members. Health plans and their brokers pay the rate in your contract.

South Dakota: TN outside city limits

South Dakota’s Community Transportation manual (updated August 2026) lists three modifiers a claim must carry when they apply: TK for an additional Medicaid recipient, TN for a trip outside of city limits, and 59 for a separate trip the same day. The state’s modifier list, effective July 1, 2026, pays TN at 150 percent of the established fee.

The fee schedule effective July 1, 2026 shows how that lands on A0120, the mini-bus code:

• In the city: A0120, $5.20 a one-way trip.
• Outside the city: A0120 TN, $7.80.
• A second rider outside the city: A0120 TN TK, $3.90. See TK modifier.
• Mileage: S0215 at $1.04 a mile, only on trips outside the city of 21 miles or more one way, between cities only, and once per trip however many riders ride.

Example: a one-way trip from one town to a clinic in another, 24 miles between the towns, pays A0120 TN at $7.80 plus 24 miles of S0215 at $24.96, for $32.76. A 15-mile trip outside city limits pays the $7.80 alone, since it is under 21 miles.

South Dakota’s secure van (A0130) and stretcher van (T2005) lines carry no TN. Their mileage, S0209 and T2049 at $2.61 a mile, is paid only outside city limits, counted from the point where the trip leaves them. See the South Dakota guide.

Alaska: TN for a rural wheelchair van pickup

Alaska’s fee schedule for state fiscal year 2027 (July 1, 2026 to June 30, 2027) pays a wheelchair van trip, A0130, $35. The same code with TN, “wheelchair van, rural,” pays $35.00 plus $0.69 a mile. Both lines need a service authorization, and the TN line also needs medical justification.

The schedule says a TN modifier “may be used to indicate a rural pick up.” Rural means an area the Census Bureau does not delineate as urbanized, and the point of pickup decides whether urban or rural rates apply. Alaska’s ambulance lines use TN the same way, such as $9.63 a loaded mile with TN against $6.42 urban on A0425. See the Alaska guide.

Medicare uses the pickup ZIP code instead

Medicare pays a rural add-on only to ambulances, and never through TN. Under 42 CFR 414.610(e), the ZIP code of the point of pickup must be reported on every ambulance claim. When that pickup is in a rural area, paragraph (c)(5) raises the ground mileage rate by 50 percent for each of the first 17 miles.

The Medicare Claims Processing Manual, chapter 15 (Rev. 13464, issued November 14, 2025), fills in the rest:

• What counts as rural. Section 20.1.4 defines it as a ZIP code located, in whole or in part, outside a Metropolitan Statistical Area, or inside one but in an area identified as rural under the Goldsmith modification.
• Each leg on its own. The pickup ZIP code of each leg decides that leg’s rural adjustment.
• Where it goes. On a paper CMS-1500, the pickup ZIP code goes in item 23 (section 30.1.2). A claim with no ZIP code there, or with more than one, is returned as unprocessable.

Arizona and Alaska also decide by where the trip starts, so a van company billing Medicaid and an ambulance billing Medicare often ask the same question: where did the rider get in?

How to bill TN without a denial

1. Find the TN line. Look for your code with TN on your state’s fee schedule or your broker’s rate sheet. No TN line means no TN.
2. Apply your program’s test. Arizona asks where the trip started, South Dakota asks whether it ran outside city limits, and Alaska asks whether the pickup is outside an urbanized area.
3. Put TN on every line the schedule lists it for. In Arizona that means the base line and the mileage line of a rural day.
4. Keep the pickup address on record. AHCCCS denies any NEMT claim without its Daily Trip Report, which records each pickup and drop-off address.
5. Follow the payer’s modifier order, such as South Dakota’s A0120 TN TK.

For rural trip planning and the math on long empty miles, see rural NEMT. For every base and mileage code TN can sit on, see NEMT billing codes.