Ambulatory transportation cost: what Medicaid pays, what private rides cost, and what changes the quote

The short answer on price

A seated ride costs less than any other level of medical transportation because it takes the least equipment and the least time. The rider walks to the vehicle, sits in a regular seat, and needs no lift, ramp, or stretcher. One driver can run it in a sedan, minivan, or small bus.

What the ride costs depends on who pays. A Medicaid member pays nothing beyond any copay, and the transportation company is paid the program’s rate. A family or a facility paying privately pays whatever the company charges. Original Medicare pays nothing for these rides, and Medicare Advantage coverage depends on the plan, as the Medicare Advantage guide explains.

This guide covers both numbers. First, what Medicaid programs pay a company for an ambulatory trip, using current fee schedules. Then, how a private quote is put together and when a cheaper option makes sense.

What Medicaid pays for a seated ride

Most programs pay a flat base for each one-way trip plus an amount for each mile the rider is on board. Vans and small buses usually bill the base under A0120 or T2003 and the miles under S0215. Taxis bill A0100. The table shows what a 10-mile trip pays under each program’s own rules.

These are fee-for-service and published broker rates. Health plans and other brokers set their own contract rates, which can land above or below the state schedule.

The rules behind each row change the math more than the base rate does:

• Indiana pays nothing for a trip’s first 10 miles. Mileage starts only once a one-way trip passes 10 miles, and even then the state subtracts those first 10, so a short trip earns the base alone. The claim must still list every mile driven with the rider aboard.
• Arizona pays more outside the two metro areas. Any trip that starts outside metro Phoenix or Tucson bills the TN modifier. Rural mileage went to $1.63 on October 1, 2026, up from $1.53. AHCCCS explains the rural rate as covering unpaved or unmaintained roads, the distance a driver covers just to get to the rider, and parts of the state with few transportation companies.
• Minnesota pays more in rural ZIP codes. Where the rider lives sets the rate. Rural and super rural trips of 17 miles or less pay 125 percent of the mileage rate, and super rural trips also get 111.3 percent of the base. A quarterly fuel adjustment then moves each mileage rate 1 percent for every 10 cents that Minnesota’s average gas price exceeds $3.00 per gallon. These amounts were originally due to expire July 1, 2026; Laws 2026, chapter 121, extended them until the new NEMT administrator the legislature ordered is running.
• Rhode Island’s MTM base covers the first 5 miles. Mileage starts at mile 5.01 when the pickup is no more than 40 miles from the provider’s vehicle base. The after-hours base for appointments between 5 p.m. and 4:59 a.m. is $21.75, and group trips to the same destination at the same appointment time pay $15.75 to $16.75 per rider.
• Colorado cut its base by two-thirds. In October 2025 the same 10-mile trip paid $66.40 ($36.40 plus $3.00 a mile). After the July 1, 2026 cuts it pays $39.55.

North Dakota is a useful contrast. Its July 1, 2026 schedule pays $27.06 for a taxi trip and $18.05 for a minibus trip, with general NEMT mileage at $0.72 a mile. Except for rides from a hospital and urgent trips, every ride needs an SFN 1507 approved in advance by the member’s human services zone or tribal office, which first checks whether a taxi is the most appropriate and economical choice.

Wheelchair and stretcher amounts for these programs sit in the Medicaid NEMT rate overview and in the rate guides for Arizona, Colorado, Indiana, and Minnesota.

Why ambulatory pays the least

The rate gap between levels tracks the work. Minnesota writes the ladder into statute. Each base below comes with its own mileage rate: unassisted $12.10, assisted $14.30, lift or ramp $19.80, stretcher $60. MTM’s Rhode Island schedule pays $17.75 for an ambulatory base, $28.50 for wheelchair, and $175.00 for stretcher. Colorado pays $12.15 for a mobility van and $34.14 for a wheelchair van.

Three costs drive that gap:

• Vehicle. Buying and insuring a sedan or minivan costs much less than a wheelchair van conversion with a lift and securement.
• Time at each end. An ambulatory rider climbs in and fastens the seat belt. A wheelchair rider needs the lift deployed, the chair strapped down, and a separate belt fastened.
• Crew. One driver handles every ambulatory trip. Some stretcher and heavy wheelchair trips need a second person.

Programs also steer riders to the cheapest level that fits. Colorado’s broker is told to use the least costly, medically appropriate means of transportation for each member, and federal rules list taxicabs and common carriers among the travel expenses Medicaid may cover (42 CFR 440.170). If a rider can walk and ride alone, the program will usually pay for a seated ride, not a van with a lift. That rule is explained in the least costly mode entry.

What goes into a private-pay price

Where no program sets the price, the company does. Most private quotes for a seated ride use some or all of these parts:

• Base fare. One flat amount per leg. It covers showing up, getting the rider settled, and the start of the drive, and some companies fold the first 5 or 10 miles into it.
• Loaded miles. A per-mile charge for the distance with the rider aboard. Companies may also bill empty miles when the pickup sits well beyond their usual territory, so ask.
• Waiting. When the driver stays at the appointment, time past an unbilled grace period is charged in 15- or 30-minute blocks. The wait time guide covers how to set it.
• Help beyond the curb. With door-through-door service, the driver comes into the home and walks the rider all the way into the waiting room. Some companies include it; others add a charge.
• An escort or caregiver. Some companies carry a relative at no charge, and some bill a per-person fee.
• After hours. Early morning, evening, weekend, and holiday trips often carry a higher base or a percentage on top.
• Late cancellations and no-shows. A fee under a written policy.

Two public numbers help an operator check whether a private price covers cost. The IRS business mileage rate comes from an annual study of car ownership and operating costs. The 2026 figure started at 72.5 cents and rose to 76 cents on July 1. Federal wage data put the May 2025 median hourly pay of shuttle drivers and chauffeurs at $17.93. A price below vehicle cost plus driver time loses money on every trip.

A company enrolled with Medicaid should also check its state’s rules before setting private prices. North Dakota, for one, has providers bill Medicaid the same usual and customary fee they charge their largest group of other customers, and a discount or free ride given to non-Medicaid riders has to be given to members too.

Example, using a made-up rate card to show the math: a $25 base that includes 5 miles, $2.50 for every mile past the fifth, and $10 per quarter hour of waiting once a free 15-minute grace period ends. A round trip of 12 miles each way, with the driver waiting 40 minutes at the clinic, prices like this:

1. Trip to the clinic: the $25 base, then 7 extra miles at $2.50 each, for $42.50.
2. Waiting: 40 minutes minus 15 free leaves 25 minutes, billed as two 15-minute steps, or $20.00.
3. Trip home: another $42.50.
4. Total: $105.00.

The same trip at a company with a lower base and a higher mileage rate could come out higher or lower, so compare totals for the exact trip, never base fares alone. Setting each part from your own costs is covered in the NEMT pricing guide, and a rate sheet gives customers the full price list.

When a taxi, an app ride, or paratransit is cheaper

A rider who walks well, needs no help at either door, and can ride alone may pay less with a taxi or an app ride on a short trip. What that rider gives up is the help: a cab or app driver is not there to wait in the lobby, carry a bag, or walk the rider inside.

Medicaid programs pay those options on their own terms:

• Arizona lists a separate, lower column for rideshare companies, used only on the schedule its health plans pay from: $4.00 per trip and $0.67 a mile in the metro areas, against $6.64 and $1.28 for a van company.
• Indiana pays a taxi with no local fare ordinance whichever is less, its own charge or a cap set by trip length, and nothing extra for mileage. Trips up to 5 miles cap at $7.63, trips of 6 through 10 miles at $12.71, and anything longer at $19.08. Where a city sets taxi fares, the cab charges the city’s meter or zone fare and Medicaid pays it up to the cap.
• Colorado pays a taxi the same $12.15 base as a mobility van but does not cover metered taxi service, and a taxi company needs separate state authority to run its cars at the mobility rate.

Paratransit is often the cheapest option for a rider who qualifies. 49 CFR 37.131 caps the paratransit fare at double what a full-fare bus or rail rider pays for a comparable trip at about the same hour. The limits are eligibility, the service area around bus routes, and booking a day ahead.

A program will not push a rider into a mode that cannot meet the rider’s needs. Minnesota’s statute shows the split: an unassisted rider goes by taxi or public transit where one is available, while a rider who needs help from the driver gets an assisted ride from a NEMT company at the higher $14.30 base.

Getting quotes you can compare

The most accurate quote comes from describing the whole trip:

1. Both addresses and the appointment time. Distance and time of day drive most of the price.
2. How much help the rider needs. Curb only, to the door, or all the way inside, plus the number of stairs at home and at the office.
3. The ride home. A fixed pickup time, a call when the visit ends, or a driver who waits.
4. Who rides along. A caregiver, an aide, or no one.
5. The total in writing. Every mandatory fee included, plus the cancellation terms.
6. An itemized receipt. The date, both addresses, and the amount, which HSA and FSA claims and the medical expense deduction depend on.

Quoting and billing seated rides in HealthRide

In HealthRide, each payer gets its own fares, so a seated trip for Medicaid, a facility, or a family gets its price at booking. Completed trips become invoices at the fares set for that payer. Families and facilities can settle up with a card kept on file or through a pay link, using our secure card processor, and a check you record goes into the same ledger. See invoicing.