New York's Verification of Medicaid Transportation Abilities Form: A Guide for Ambulette Companies

What Form 2015 does

New York Medicaid pays for the lowest cost ride that is medically appropriate, and it expects members to travel to care the way they travel for daily life. In New York City that usually means a bus or the subway. Form 2015, the Verification of Medicaid Transportation Abilities, is how a medical provider shows that a member needs more. The Department of Health’s Form-2015 policy (version 2022-1, effective June 6, 2022) calls it the medical justification for a specific mode.

State rule 18 NYCRR 505.10 makes the form part of every ambulette and non-emergency ambulance request. Under the 2022-1 policy it also backs taxi and livery requests, unless the member lives more than half a mile from a public transit route in New York City or more than three quarters of a mile elsewhere. Public transit never needs it.

The form supports the prior authorization. It does not replace it. Medical Answering Services (MAS), the state’s Medicaid transportation broker, still approves each trip, and the 11-digit prior authorization number that goes on your claim comes through it. For licenses, enrollment, and rates, see the New York guide.

Who fills it out

The member’s medical provider does, through the MAS online portal. Since June 6, 2022, forms sent any other way are not processed. When a provider books a trip in the MAS system, the system asks for an electronic Form 2015 whenever the mode needs one.

Your company has no part in completing it. The Medicaid Transportation Policy Manual (effective August 25, 2023) says it is inappropriate for a transportation provider to request prior authorization. The standing order policy (effective October 1, 2020) names transportation providers among those who may not enter standing orders. And the regulation requires practitioners to complete these forms at no cost to the member.

Which riders qualify for an ambulette

Under 505.10(c)(2), as amended effective November 24, 2021, a practitioner may order an ambulette when any one of these is true:

1. The member must ride lying down, and the ambulette has stretcher capacity.
2. The member uses a wheelchair and cannot use a taxi, livery, bus, or private vehicle.
3. The member has a disabling physical condition that requires a walker, crutches, or other mobility equipment, and cannot use those modes either.
4. The member has another disabling physical condition, or a disabling mental condition, that requires an ambulette’s personal assistance, and the practitioner certifies that a taxi, livery, bus, or private vehicle will not work.
5. An otherwise ambulatory member gets radiation, chemotherapy, dialysis, or other ongoing chronic care treatment that leaves them unable to use a taxi, livery, rideshare, bus, or private vehicle afterward.

Non-emergency ambulance is a separate level. It is for a member who needs medical treatment or monitoring on the way that only a state certified EMT or higher can give (505.10(c)(3)).

Personal assistance is what makes a trip an ambulette trip. The policy manual defines it as hands-on help walking, on stairs, ramps, and curbs, with doors, getting into the vehicle, and moving wheelchairs and equipment, from the member’s door to the provider’s door, with no limit on stairs or floors. MAS’s network manual (October 1, 2023) also defines an ambulatory level for members who can walk but need that help door through door, and it must run in an ambulette vehicle. If a member needs no personal assistance, New York City’s ordering guidelines for medical providers (version 2017-1, May 8, 2017) say livery is the mode to request.

Stretcher service is for a member confined to bed who cannot sit in a wheelchair and needs no medical monitoring. The policy manual says a stretcher is not the right mode just to make a transfer onto an exam table easier. See stretcher van requirements.

The levels the form backs

The form is needed for every level above public transit, with one exception for taxi riders who live far from a transit route.

Ride level	Who it is for	Form 2015
Public transit	Members who ride it for daily life	Not needed
Taxi or livery	Members who cannot use transit and need no hands-on help	Needed, unless the member lives far from a transit route
Ambulette	Members who need personal assistance, a wheelchair, or a stretcher	Needed
Non-emergency ambulance	Members who need treatment or monitoring by an EMT on the way	Needed

Who can sign it, and who can order the ride

Two lists apply, and they are not the same.

Who can sign Form 2015. The 2022-1 policy limits it to a physician, physician assistant, dentist, registered nurse, nurse practitioner, occupational therapist, physical therapist, licensed master social worker (LMSW), licensed clinical social worker (LCSW), or mental health counselor. They sign and date it with their own NPI.

Who can order an ambulette. Under 505.10(d)(8), the written order comes from the member’s attending physician, physician assistant, nurse practitioner, dentist, optometrist, podiatrist, or another practitioner the Department approves. A non-emergency ambulance order must come from the attending physician, a physician assistant, or a nurse practitioner (505.10(d)(7)). A hospital, nursing home, clinic, intermediate care facility, long term home health care program, home and community based waiver program, or managed care program may submit the order on the practitioner’s behalf.

The ordering practitioner carries duties of their own. They must note in the member’s record the condition that justifies the ambulette or ambulance, and keep a copy of the completed form (505.10(c)(4)). A practitioner or facility that orders rides outside these rules can face monetary claims and program sanctions.

The ordering practitioner also appears on your claim. eMedNY’s transportation billing guidelines (version 2026-02, August 5, 2026) require the ordering provider’s NPI in field 23 for ambulette, non-emergency ambulance, taxi, and livery trips. It comes from the prior authorization roster, and claims without it are rejected.

What gets a form approved or rejected

To be approved, the 2022-1 policy says the form must be fully completed, clearly describe the diagnosis or condition that requires the mode, and give the expected length of time the member will need it. MAS may ask the provider for more information, and anything missing delays the decision.

MAS may reject a form that:

• is not fully completed,
• is not signed and dated by the provider with their own NPI,
• is signed by someone outside the listed titles,
• is illegible,
• does not support the need for the mode,
• gives only a diagnosis or diagnosis code without describing how the member gets around, or
• was not sent through the portal.

The city’s 2017 ordering guidelines, still posted on eMedNY as of October 2026, list justifications that get a form rejected on their own, among them “needs assistance,” “weak,” “car service,” “anxiety,” and “likes to ride alone.” A form holds up when it ties the condition to what the member cannot do on the trip, such as walking to a bus stop or managing stairs without hands-on help.

Patterns draw attention. When one provider sends many forms with similar justifications, the Department is alerted, and the provider may have to meet with MAS and resubmit corrected forms. If a facility asks your staff what to write, send them to MAS.

How long a Form 2015 lasts

One approved form can cover one trip or many, including standing orders. The provider renews it through the portal:

• at least once a year,
• at the end date on the current form, or
• when the member’s condition calls for a different mode.

The policy also requires an update whenever the member’s status changes in any way, and the Department and MAS can ask for a new form at any time.

Standing orders run on their own clock. Under the standing order policy, an order lasts no more than six months from its start date. Only the medical provider or a designee, such as a nurse, scheduler, or receptionist, can enter or renew it, and they confirm their identity with a code sent to a professional email address. MAS sends reminders before an order expires. So a rider with a current Form 2015 can still lose a dialysis schedule if the six-month order lapses. See NEMT standing orders.

When a rider’s mobility changes partway through, the facility makes the change, not you. The ordering guidelines give the case of a dialysis patient who rides an ambulette, has a stroke, and now needs a stretcher. The facility must contact MAS to change the mode.

What your ambulette company keeps on file

You do not hold the Form 2015. It stays with the ordering practitioner, who must keep a copy, and with MAS, which reviews it. What you keep is proof that each trip happened at the level MAS approved.

1. The trip as MAS sent it. Your Trip Roster in the MAS system lists your assigned trips, and every change there is signed and time stamped.
2. The prior authorization number and the ordering NPI. Both go on the claim, and each prior authorization needs its own claim form.
3. A record for every leg. The policy manual requires the member’s name and Medicaid ID, the date, the pickup place and time, the drop-off place and time, the plate number, the driver’s license number, the driver’s printed name and signature, and the driver’s attestation. Keep it six years from the date of payment. See NEMT trip documentation.
4. Your attestation, on time. Attest each trip within 30 days of the date of service.

Auditors check each claim against your trip records. The Office of the Medicaid Inspector General’s ambulette audit protocol (revised July 22, 2026) disallows a claim when the trip record lacks any of 11 items for either leg. When a claim carries the wrong procedure code, it takes back the difference between the code billed and the correct code. The policy manual adds that an ambulette company that billed without giving personal assistance can face financial or other sanctions.

When the ride level on a trip looks wrong

Sometimes the trip on your roster does not match the rider at the door. A rider booked at the ambulatory level now uses a wheelchair, or a wheelchair rider can no longer sit up for the ride. Here is what to do:

1. Do not change the level yourself. MAS’s network manual says providers keep to the times and addresses on every trip and send changes to MAS. Its provider FAQ warns against changing a trip because a rider or medical provider asked, and says a changed invoice may not be processed.
2. Call MAS before the ride if you can. Changes requested after the service may not be approved. The transportation provider hotline is 1-866-242-2578.
3. Ask the rider’s medical provider to renew Form 2015. A new mode needs the provider’s update in the portal.
4. Bill only the level MAS approved. The claim has to match the prior authorization.
5. Never leave a door through door rider at a closed or unreachable entrance. MAS says to bring the rider back to the pickup location.

Sometimes it goes the other way, and a rider booked for an ambulette needs no hands-on help. That change also goes through MAS and the rider’s provider. Your ambulette vehicle can still run a trip MAS approves as taxi. MAS’s provider FAQ says Medicaid pays the taxi rate for taxi service in a properly licensed vehicle, once the Department and MAS have approved your company for taxi or livery trips. The policy manual also lets ambulette companies use sedans and minivans for livery trips.

One more line to hold: never offer a clinic, a doctor, or a rider anything of value to steer trips your way. MAS calls it illegal and reports it to the Department. See anti-kickback rules for NEMT.

Trips outside the rider’s area: Form 2020-U

New York pays for rides within the member’s common medical marketing area, the area where their community usually gets care. Under 505.10(d)(12), a trip to care outside that area may be denied when the same care is available inside it. It may be approved when the member needs to continue a course of care with a specific provider.

A trip outside the area needs Form 2020-U, the Request for Transportation Outside the Common Medical Marketing Area. Its rules come from MAS’s policy (version 2018-1) and the form itself:

• The referring physician completes and signs it. The physician who will see the member does not.
• It asks whether the care is available locally, and if so, why local care will not work. Continuity of care with no specific reason is denied right away.
• MAS asks for it at least 7 business days before the appointment, through the portal or by fax to 315-299-2786.
• It does not guarantee approval. MAS may also ask for a letter of medical necessity, and it will not approve the trip when the member’s own actions ended their care with local providers.

The Department restated the rule on May 29, 2025, in a reminder with the Office of Addiction Services and Supports about opioid treatment and outpatient addiction programs. When a member’s standing order is about to expire, MAS checks with the program whether care is available closer to home. The member may need to move to a closer program to keep Medicaid rides, and in New York City a member who stays with a program outside the area gets public transit instead. If you run standing orders to these clinics, expect some to end or move at renewal. See methadone clinic rides.