AHCCCS NEMT rates for fiscal 2027: the urban and rural fee schedule, code by code

The fiscal 2027 schedule at a glance

AHCCCS, Arizona’s Medicaid agency, pays each ground NEMT trip a base amount and then a per-mile amount for every loaded mile. Rural trips, meaning those picked up outside the Phoenix and Tucson metro areas, have their own column. The schedule below applies to trips on or after October 1, 2026, and covers trips AHCCCS pays itself on a fee-for-service basis.

Two things stand out. The rural stretcher van base is $37.61 higher than the metro base, the biggest rural gap on the schedule. And wheelchair and stretcher vans share the same mileage rate, so on a long trip most of the difference between them comes from the base.

The spreadsheet also carries a second column labeled PT NT. Those lower rates apply to transportation network companies and are set only for the capped fee schedule AHCCCS publishes for its health plans. A registered NEMT company billing AHCCCS directly uses the fee-for-service column. For how these amounts compare with other states, see how much Medicaid pays for NEMT.

Which trips these rates pay

The fee-for-service schedule applies to members AHCCCS pays for directly: the American Indian Health Program (AIHP), Tribal ALTCS, TRBHA members, and other fee-for-service populations. NEMT is not covered for members of the Federal Emergency Services Program.

Members of AHCCCS Complete Care plans and the other managed care programs get their rides from the plan, often through an NEMT broker it contracts. Those trips pay the rate in your contract with the plan or broker, not this schedule. The Arizona state guide lists which plans use which broker.

Chapter 14 of the fee-for-service manual adds that payment depends on the code billed, not the member’s program. The manual states there is no difference in reimbursement between fee-for-service and ALTCS members.

Urban or rural: when to add TN

A trip is urban when it starts inside the Phoenix or Tucson metropolitan area. Every other trip is rural and must carry the TN modifier on its codes. According to AHCCCS, the higher rural rate is there to cover atypical conditions such as roads that are unpaved or not maintained, long distances just to reach the member, and a shortage of local providers.

The rural premium differs sharply by service:

• Wheelchair van: $1.06 more per trip and $0.12 more per mile.
• Stretcher van: $37.61 more per trip and $0.12 more per mile.
• Ambulatory mileage (S0215): $0.35 more per mile from October 1, 2026.
• Waiting time and private vehicle mileage: no difference.

Waiting time: $4.59 per unit, with five exclusions

T2007 pays $4.59 for each 30 minutes the driver actually waits at the medical destination. It applies only when the distance made it impractical to return to your base or to the pickup point. If you carry several members at once, you are paid waiting time for one of them.

Chapter 14 rules out T2007 when:

1. The odometer moves between dropping the member off and picking them up again.
2. The trip is one way.
3. Different vehicles or drivers handle the two legs.
4. The wait is under 30 minutes.
5. The appointment is 10 miles or less from the pickup.

Waiting time is billed on claim line 3, below the base and mileage lines. AHCCCS audits wait time after payment along with mileage and medical necessity.

Billing a member’s day on one claim

AHCCCS expects one claim per member per date of service, holding every trip that member took that day. Line 1 carries the base code with one unit per trip, line 2 carries the total loaded miles for the day, and line 3 carries any waiting time. Additional lines deny. A second claim for the same member and date denies as a duplicate, and sending the base and the mileage on separate claims counts as split billing and denies too.

The rest of the billing rules that shape what you get paid:

• Prior authorization over 100 miles. A member’s trips on one date of service need prior authorization when they total more than 100 miles, counting one-way, round, and multiple trips. Only the base and mileage codes get authorized. IHS and tribal 638 providers are exempt.
• Loaded miles only. Miles count in statute miles with the member on board. No claim may include unloaded miles, and picking up a prescription on a member’s behalf is not billable.
• Matching legs. If the outbound and return legs differ in loaded miles, explain why on the Daily Trip Report. Without a reason, AHCCCS may cut the difference.
• Diagnosis codes. If the diagnosis is unknown, use R68.89 for physical health or F99 for behavioral health.
• Family and caregiver trips. Since July 1, 2022, transporting a family member or caregiver to a treatment-plan service without the member present is covered in some cases, billed with the HS modifier.
• Pharmacy trips. AMPM 310-BB covers rides to fill Medicare Part D prescriptions. Plan members in Maricopa and Pima counties get pharmacy rides only within 15 miles one way unless the plan authorizes a specialty pharmacy.

Claims go through the AHCCCS Online portal, as an 837P, or on a paper CMS 1500. The NEMT billing codes guide explains the codes beyond Arizona.

The Daily Trip Report and addresses on the claim

AHCCCS denies any fee-for-service NEMT claim that arrives without its Daily Trip Report, the form printed as Exhibit 14-1. You cannot design your own version. Filling it out on a tablet is fine if member data is protected and both signatures are handwritten on the screen, by stylus or finger. Typing a name in place of a signature is not accepted, and a driver can never sign on the member’s behalf.

For each leg, the report records the driver, the vehicle’s plate and make, the member, full pickup and drop-off addresses, clock times, odometer readings at pickup and drop-off, the trip type, and the member’s signature. Where there is no street address, coordinates or a nearby landmark with the distance from it are accepted.

Since November 1, 2022, the claim itself must also show the pickup and drop-off addresses. Electronic and portal claims put the full addresses in the Additional Information field. Paper claims use Box 19 with street address and ZIP code only, in the form “P- 1234 E Berry St 85000, D- 678 N Town St 85222”. Chapter 14 warns that incomplete trip records can be cited in an audit and the payment taken back, so treat the trip log as part of the bill.

Filing limits

Arizona law gives you six months from the date of service to get the first claim to AHCCCS, or six months from the date eligibility is posted when coverage is retroactive. A first claim received later is denied.

A claim that arrived on time can still be corrected or adjusted for a full year from the date of service. If it has not reached clean claim status by then, AHCCCS is not liable for it. The timely filing limit entry compares these windows with other states.

How the schedule has changed

The ground NEMT schedule has barely moved in six years. The rates effective October 1, 2020 match those in the October 2025 schedule code for code, apart from one temporary line.

The fiscal 2027 increase was announced in AHCCCS’s preliminary rates notice, posted July 24, 2026, with comments closing August 24. The notice estimated a total fee-for-service increase of about $6.3 million across all services for October 2026 through September 2027.

A worked example

Here is a hypothetical rural wheelchair van round trip, picked up in a town beyond the Phoenix and Tucson metro areas: 32 loaded miles each way, a 90-minute wait at the appointment, the same van and driver both ways, and no odometer change during the wait.

The day’s total is 64 miles, under the 100-mile threshold, so no prior authorization is needed. The same trip starting in Phoenix would pay $22.30, $98.56, and $13.77, or $134.63. If the clinic were 10 miles or closer, line 3 would drop off entirely.

Keeping trip records straight in HealthRide

AHCCCS audits come down to whether each leg’s addresses, times, and miles hold up. In HealthRide, the driver app logs GPS-recorded miles and clock times for each leg while the driver works, and riders sign on the phone’s screen. Export the trip log to CSV or PDF and you have a second record to check every Daily Trip Report against before you bill.