New York Medicaid Transportation Forms: Form 2015, Form 2020 and What You Need

Do you need a form to book a Medicaid ride?

You never complete a transportation form yourself. New York runs non-emergency Medicaid transportation through a broker, Medical Answering Services (MAS), and you book over the phone or online. Give your Medicaid client identification number (CIN), the confirmed appointment, and your pickup address, then request DachiPlus by name. Our MAS Medicaid guide and step-by-step booking walkthrough cover exactly what to say on the call. Whether a form is involved depends on how you travel. Medicaid expects you to use the same mode you use for daily activities, and when your medical provider asks for a specific higher mode, they back the request with Form 2015. A second form, Form 2020, comes in only when the care you need is outside your local area.

What is Form 2015?

The 2015 form is the Verification of Medicaid Transportation Abilities (NYS Form-2015; MAS lists it as the 2015 Verification of Transportation Abilities form). The 2015 is a New York State Department of Health form number, not a year, which is why the search looks dated even though the form is current. Under the Department of Health's Form-2015 policy, Medicaid pays for the lowest-cost, most medically appropriate mode, and medical providers complete Form-2015 to give the medical justification when they request a specific mode for you, such as taxi or livery, ambulette, or ambulance. To be approved, the form must be fully completed, clearly describe the diagnosis or medical condition that makes that mode necessary, and state how long you are expected to need it.

Who can sign it is set by the state: a physician, physician assistant, dentist, registered nurse, nurse practitioner, occupational therapist, physical therapist, licensed master social worker, licensed clinical social worker, or mental health counselor. Since June 6, 2022, the form must be submitted through the MAS online portal; forms sent any other way are not processed. One approved form can cover a single trip or a series of trips, including a standing order, and your provider renews it at least once a year, at the end date on the form, or whenever your condition calls for a different mode. Form-2015 does not replace prior authorization: MAS still has to authorize your trips, and the form supports the request for that mode. See does Medicaid pay for an ambulette for how this plays out on a real Suffolk County trip.

Which form applies to your level of service?

The form you need depends on how you travel, not on the appointment itself:

• Public transit: no Form 2015 is needed.
• Taxi or livery (an ambulatory car ride): MAS requires your medical provider to submit Form 2015 showing why you cannot use public transit. The Department of Health policy makes one exception: outside New York City, the form is not required for taxi or livery if you live more than three-quarters of a mile from a public transit route. This is the standard Medicaid ride DachiPlus drives in Nassau and Suffolk.
• Ambulette (wheelchair van): Form 2015, documenting why you cannot travel by taxi, livery, private vehicle, or public transit. This is the ambulette service level.
• Stretcher or non-emergency ambulance: Form 2015 with the justification for that level, used when you are bed-bound or cannot sit upright for the trip.

One point of confusion is worth clearing up: the Physician Certification Statement (PCS) is a Medicare form for scheduled non-emergency ambulance rides. It is not the form for Medicaid taxi, ambulette, or wheelchair van trips, which use Form 2015 instead. If you are on Medicare or a Medicare Advantage plan, check how Medicare covers transportation so you request the right document from the start.

What is Form 2020? Care outside your common medical area

Form 2020 is the Request for Transportation Outside the Common Medical Marketing Area (NYS DOH Form 2020-U). Medicaid transportation rules tie covered rides to your common medical marketing area (CMMA): the area where your community customarily gets its medical care. The CMMA is not necessarily set by county lines and can vary with the specialty you need. You are free to choose any medical provider, but the Department of Health explains that Medicaid covers rides to a provider outside your CMMA only when a referring provider completes the 2020 form confirming the care you need is not available locally.

Under the state's CMMA policy, travel outside the area is appropriate only when the care is not available within it, when you need to continue a specialized course of care with a specific provider, or in other circumstances unique to you that MAS or the Department of Health find appropriate. The referring physician completes and signs the form, not the doctor you are being sent to, and includes the medical justification, the diagnosis, and how long care will last. MAS asks for it seven business days before the appointment. Completing it does not guarantee approval: the form itself warns that "continuity of care" without specific reasons is denied, and MAS will not authorize out-of-area trips when you cannot be treated locally because of your own non-compliance with local providers. This can come up when a Nassau or Suffolk rider is referred to a specialist in New York City. Your doctor's office can download the official Form 2020 (PDF) or submit it online through MAS.

Standing orders: recurring trips

If your appointments repeat, you do not have to book every trip. Your medical provider can set up a standing order: prescheduled rides to the same location at the same times and days, for up to six months, after which the provider renews it. Under the state's standing-order policy, in effect since October 1, 2020, MAS accepts standing orders only from your medical provider or their staff through its online system; you, your family, and transportation companies cannot enter one. The request includes a field for a preferred transportation provider, so ask the office to list DachiPlus. Standing orders are standard for dialysis transportation three times a week, and for daily radiation or chemotherapy cycles. Riders traveling across Nassau County towns like Hicksville and Long Beach, or across Suffolk County from hamlets like Bay Shore and Brentwood, use standing orders so they never re-book a routine run.

Attendant and companion authorization

If a family member or aide needs to ride with you, tell MAS when you book, not the driver at pickup. The state's Medicaid Transportation Policy Manual defines a transportation attendant as someone the prior authorization official (MAS) authorizes to accompany and assist you, and it allows transportation companies to provide only the services MAS has authorized. A companion who simply rides along, such as a spouse helping a frail parent to a doctor's visit, still needs to be mentioned at booking so the right vehicle is sent. Our guide on whether a family member can ride along explains the difference and when documentation is required.

Why forms get rejected, and how to avoid it

The Department of Health's Form-2015 policy lists the reasons a form may be rejected: it is not fully completed; it is not signed and dated by your medical provider using their own NPI number; it is signed by someone outside the approved titles; it is illegible; the justification does not support the mode requested; it gives only a diagnosis or diagnosis code without describing how you get around; or it was not submitted through the portal. The fix is straightforward: ask your provider's office to describe your specific mobility limits, not just the diagnosis, before the request goes to MAS. DachiPlus confirms your assigned mode before pickup, so a paperwork gap does not leave you waiting at the curb anywhere across Nassau or Suffolk County. To make sure the rest of your file is ready, review Medicaid transportation eligibility in New York and what a CIN number is before you call.

Private pay: no state form needed

If you are not on Medicaid, there is no state form at all. Private-pay and insurance rides book directly with the provider. Call DachiPlus at (516) 754-7777 for a flat quote, and we coordinate the coverage and payment options that apply to your situation, from Medicare Advantage to no-fault auto and workers' comp. Any paperwork on those trips is handled between us and the payer, not by you. You can also read what your Medicaid transportation benefit covers if you are not sure which program applies.

Frequently asked questions

What is the 2015 form for Medicaid transportation?

It is the Verification of Medicaid Transportation Abilities form (NYS Form-2015). The 2015 is a New York State Department of Health form number, not a year. A licensed medical provider completes it to justify a specific mode of transportation, such as taxi or livery, ambulette, or non-emergency ambulance, when your condition means you cannot travel the way you do for daily activities. Since June 6, 2022 it must be submitted through the MAS online portal.

Do I need to fill out a form to book a Medicaid ride in New York?

You never fill one out yourself. You book through MAS at 1-844-666-6270 or online and give your Medicaid CIN and appointment details. If you travel by public transit, no Form 2015 is needed. For a taxi or livery, ambulette, or ambulance, your medical provider usually submits a Form 2015 to MAS. Outside New York City, it is not required for a taxi or livery if you live more than three-quarters of a mile from a public transit route.

Is the Medicaid transportation form the same as the Medicare PCS?

No. The Physician Certification Statement (PCS) is a Medicare form for scheduled non-emergency ambulance trips. Medicaid rides above public transit use the NYS Form-2015, the Verification of Medicaid Transportation Abilities, instead. They are different documents for different programs.

Where do I get the 2015 form?

You do not download or file it yourself. Your medical provider completes, signs, and submits Form-2015 through the MAS online portal; forms sent any other way are not processed. If you are unsure whether yours is on file, ask your provider's office, or call DachiPlus at (516) 754-7777 and we can help you confirm before pickup.

What is the 2020 form for Medicaid transportation?

It is the Request for Transportation Outside the Common Medical Marketing Area (NYS DOH Form 2020-U). Medicaid generally covers rides only to care inside your common medical marketing area, the area where your community usually gets its medical care. If you need a provider outside it, your referring physician completes and signs the 2020 form. MAS asks for it seven business days before the appointment, and completing it does not guarantee approval.