A1255 is the OASIS-E2 transportation item, and it's the biggest structural change in this version. CMS didn't just renumber A1250 — they replaced it with a new item that asks a different question, over a different timeframe, with different response codes, at different time points. If you're on autopilot from OASIS-E1, you'll get this wrong. This is part of our OASIS-E2 series.
TL;DR
- A1250 → A1255. Not a renumber — a replacement.
- Lookback: 12 months (was 6 months in A1250).
- New word: "reliable" — "lack of reliable transportation."
- New activities included: "meetings, work" (added to medical appointments + daily living needs).
- New response codes: 0 = Yes, 1 = No, 7 = Declines, 8 = Unable. (A1250 used letter codes A/C/X/Y.)
- Single-select. A1250 was check-all-that-apply. A1255 is one response only.
- Time points: SOC and ROC only. A1250 was also collected at Discharge — A1255 is not.
Who this is for
Field clinicians completing SOC and ROC OASIS assessments. QA reviewers updating audit checklists. EHR teams confirming the new response codes flow through correctly.
The Item, Verbatim
A1255. Transportation. In the past 12 months, has lack of reliable transportation kept you from medical appointments, meetings, work or from getting things needed for daily living?
- 0 = Yes
- 1 = No
- 7 = Patient declines to respond
- 8 = Patient unable to respond
- Dash (-) = No information (rare)
Memorize the wording. It's a patient-interview item — you ask the question as written, and you code the response the patient gives you.
A1250 vs A1255: Side-by-Side
| Element | A1250 (OASIS-E1) | A1255 (OASIS-E2) |
|---|---|---|
| Lookback period | Past 6 months | Past 12 months |
| Qualifier | Lack of transportation | Lack of "reliable" transportation |
| Activities included | Medical appointments + daily living needs | Medical appointments + meetings + work + daily living needs |
| Response format | Check all that apply (A/C/X/Y) | Single-select (0/1/7/8) |
| Time points | SOC, ROC, Discharge | SOC, ROC only (not Discharge) |
| Aligned with | Older SDOH framework | PRAPARE screening tool |
The "reliable" word matters. A1250 asked whether transportation had been an issue at all. A1255 asks whether unreliable transportation specifically caused the patient to miss things. A patient with a car that occasionally breaks down, who has missed appointments because of it, would code Yes — even if they had transportation most of the time.
Two Realistic Scoring Scenarios
Scenario 1: Urban patient with intermittent rideshare access
You're doing a SOC visit on a 71-year-old woman in a city apartment. She doesn't drive. She uses a mix of family rides, paratransit, and Uber. She tells you that in the past year she missed two cardiology follow-ups because paratransit was canceled and her daughter couldn't take off work.
Score: 0 = Yes. Lack of reliable transportation kept her from medical appointments in the past 12 months. Note that the question doesn't ask about current transportation status — it asks about the past 12 months. Even if her transportation has been fine for the last month, the past-year history triggers a "Yes."
Documentation:
Patient reports lack of reliable transportation in the past 12 months. Missed two cardiology appointments due to paratransit cancellations and family unavailability. A1255 = 0 (Yes).
Scenario 2: Rural patient with one reliable car
Patient is a 68-year-old man in a rural area, 40 minutes from the nearest hospital. He has one reliable vehicle and his wife drives. They've made every appointment for the past year. He works part-time and has not missed work due to transportation.
Score: 1 = No. Reliable transportation has not been a barrier in the past 12 months — even though he lives in a transportation-fragile area, the actual history is "No barriers."
A common error is to over-interpret rural geography as automatically "Yes." A1255 asks about the patient's experience, not their environment. A rural patient with reliable family support codes No. An urban patient with unreliable family support codes Yes.
Why CMS Made This Change
A1255 is part of CMS's broader Social Determinants of Health (SDOH) data strategy. The item is intentionally aligned with the PRAPARE screening tool (Protocol for Responding to and Assessing Patient Assets, Risks, and Experiences) used in community health centers and FQHCs. This alignment lets CMS — and researchers — compare transportation data across home health, primary care, and other settings using a consistent question.
The 12-month lookback (vs A1250's 6 months) matches PRAPARE. The "reliable" qualifier matches PRAPARE. The single-select format matches PRAPARE. None of this is arbitrary; it's all about cross-setting data compatibility.
Common Mistakes to Avoid
- Forgetting it's no longer at Discharge. If your old workflow included A1250 at the discharge OASIS, you need to remove that step. A1255 is SOC and ROC only.
- Using the old letter codes (A/C/X/Y). The new response set is numeric (0/1/7/8). Your EHR should default this correctly, but if you're scoring on paper, double-check.
- Asking the question paraphrased. The wording matters — "reliable transportation," past 12 months, including meetings/work. Read the question as written.
- Assuming "no car" means "Yes." A patient without a car who has reliable family support and has not missed any appointments codes No. A patient with a car that breaks down and has missed appointments codes Yes.
- Coding based on current status. The question is past-12-month historical, not current.
Frequently Asked Questions
What if the patient doesn't have any medical appointments to miss?
Use the patient's broader experience over the past 12 months. The question asks about medical appointments, meetings, work, or daily living needs. If lack of reliable transportation kept them from grocery shopping, getting to a community center, or other daily living needs, code Yes.
Does it count if a family member missed work to drive the patient?
That's a workaround, not a transportation problem in the patient's own life. The question asks whether the patient was kept from things — focus on what the patient missed, not what their caregiver had to give up.
What if the patient is unsure?
If you've asked the question clearly and the patient genuinely cannot answer, use response 8 (Patient unable to respond). Use 7 (Declines) if they refuse to answer. Use the dash response only when the patient interview is impossible (e.g., severe cognitive impairment with no proxy available) — CMS expects dash use to be rare.
Why is A1255 not at Discharge anymore?
CMS removed it from the Discharge time point because the SDOH transportation data is most useful at SOC/ROC for care planning purposes. Tracking transportation barriers at discharge added documentation burden without yielding actionable data.
Does A1255 affect payment or quality measures?
Not directly. It's an SDOH item used for risk stratification and population analytics. It doesn't feed PDGM grouping or current quality measures, but the data may inform future risk adjustment models.
Sources
- OASIS-E2 Guidance Manual (CMS) — A1255 item instructions
- OASIS-E2 All Items (CMS, effective 04/01/2026)
- OASIS-E1 to OASIS-E2 Change Table
- OASIS Transportation Item: What's New with E2 (OASIS Answers) — third-party explainer
- PRAPARE Screening Tool — the SDOH framework A1255 aligns with
Info
This article is part of our OASIS-E2 series. See also: the OASIS-E2 Cheat Sheet (full overview), Intercepted Falls Documentation, and A0810 Replaces M0069.
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