Colorado Medicaid NEMT rates in 2026: the HCPF fee schedule, the July cuts, and MediDrive

Rates in effect since July 1, 2026

Health First Colorado, the state’s Medicaid program, prices each NEMT trip in two parts: a flat amount for every one-way trip and an amount for every mile, with separate codes for each kind of vehicle. HCPF (the Department of Health Care Policy and Financing) publishes the rates in one spreadsheet with a column for each change. The current column took effect July 1, 2026, the first day of the state’s 2026 to 2027 fiscal year.

The same schedule lists non-emergent ambulance rates, including $174.47 for a BLS trip (A0428) and $6.28 per mile for in-state ground ambulance mileage (A0425). A0425 is for ambulance trips only.

One detail stands out: stretcher van mileage pays $0.88 less per mile than wheelchair van mileage. The stretcher base is $15.28 higher, so past about 17 miles a stretcher trip pays less than a wheelchair trip of the same length.

What changed on July 1, 2026, and why

The July 2026 schedule carries two kinds of cuts. The first is targeted at the ambulatory side of NEMT. HCPF’s rate reduction fact sheet set taxi and mobility vehicle trips at $12.40 and taxi, mobility, and wheelchair van mileage at $2.80 per mile, effective July 1, 2026. The second is a 2 percent across-the-board reduction for most provider types, enacted through HB 26-1410. NEMT is not on the exemption list, so the targeted rates came down a further 2 percent to $12.15 and $2.74. HCPF notes that all rate adjustments are subject to CMS approval.

Most codes had already come down once, in October 2025. The two mileage codes set at $3.00 were the exception. Here is how the main codes moved:

The October 2025 drop came from Executive Order D 2025 014, issued during a revenue shortfall, which removed the 1.6 percent increase providers had received on July 1, 2025. The April 1, 2026 cap at 85 percent of Medicare rates did not touch NEMT, because HCPF lists NEMT among the services already paid below that level.

Mileage tells a longer story. In July 2024, wheelchair van mileage paid $1.19 a mile, and taxi and mobility trips billed their miles under A0425. From July 1, 2025, taxi and mobility mileage moved to S0215, and both mileage codes paid $3.00 until this July.

XL wheelchair trips (A0130 U9)

Since November 1, 2025, Colorado pays a separate rate for XL wheelchair transportation when two attendants help load and unload the member. Bill A0130 with modifier U9. It paid $65.00 when it started and $63.70 from July 1, 2026, nearly double the standard wheelchair base. A wheelchair trip that uses one attendant is billed as plain A0130. The manual briefly listed the modifier as U1 before correcting it to U9 on November 12, 2025, so check older claims for that error. The U modifiers entry explains how states use this family of codes.

How mileage is counted

Colorado pays mileage for the shortest trip length, measured by an internet map, trip planner, or GPS. Bill the vehicle’s own mileage code: S0209 for wheelchair vans only, S0215 for taxis and mobility vehicles, T2049 for stretcher vans.

Two distance rules decide whether long trips get paid:

• The 25-mile rule. The ride must go to the closest qualified provider, which the manual defines as any within a 25-mile radius of the member’s residence, or the nearest one when no provider practices inside that radius. Longer trips need the Verification Form for Transportation Services More Than 25 Miles, completed by the member’s treating or referring provider. It can be signed after the trip, stays valid for 90 days for recurring care such as dialysis, and goes in with the claim.
• The daily mileage edit. Claims for A0425, S0215, or S0209 are suspended for review above 52 units, or above 125 units for members who live in one of 40 designated rural counties (a change that took effect September 30, 2025). Suspended claims deny without an attachment that shows addresses, times, driver, vehicle, trip confirmation, and the treating provider’s reason for bypassing closer care.

Empty miles are not paid either. The manual rules out any charge for time the member is not in the vehicle, other than meals and lodging. The loaded miles entry explains the distinction.

Meals, lodging, and escorts

Colorado pays ancillary costs when a trip cannot be done in one calendar day, or for approved out-of-state care when meals and lodging are not part of an inpatient stay. Payment is the amount actually charged, up to the per diem, one unit per day each.

Colorado covers an escort for a member who is a child, or an at-risk adult unable to make medical decisions or look after their own needs, once the member’s enrolled provider puts that in writing. A second escort needs the provider’s written certification of medical necessity, for example when one escort could not keep the member from harming themselves or others. Members aged 13 to 17 can ride without an escort if a parent or guardian signs a release and an adult meets them at the destination and again at the return stop. Anyone under 13 must have an escort. The ancillary codes guide covers these codes in other states.

What Colorado does not pay

The manual’s exclusion list is short and strict. Health First Colorado NEMT does not pay for:

• Waiting time or cancellations.
• Response calls where, on arrival, no transport is needed or provided (a dry run).
• Metered taxi service.
• Extra passengers, unless they are the escort for a child or at-risk adult.
• A second claim when two members ride to the same place in the same vehicle. Only one member’s ID goes on the claim.
• Rides that take nursing facility or group home residents to services the facility itself must provide, unless it has no vehicle free.

Billing today: inside and outside the metro broker area

Where you send the claim depends on where the trip happens until the statewide switch.

In the nine metro counties (Adams, Arapahoe, Boulder, Broomfield, Denver, Douglas, Jefferson, Larimer, and Weld), MediDrive took over as broker on July 1, 2026. Trips there are paid only by the broker and cannot be billed to HCPF.

In the other 55 counties, NEMT providers take requests, check member eligibility, keep the required forms, and bill HCPF directly through the Provider Web Portal or an 837P. The core rules:

1. One date of service per claim. Span billing is not allowed.
2. Diagnosis code R68.89 on every claim, and place of service 41 for land trips.
3. Modifier 76 for repeat trips by the same member with the same provider on one day, and 77 when a different provider does the later trip.
4. Your usual and customary charge in the charges field for each line, without subtracting copays or other insurance payments.
5. The Department’s Standard Trip Log, required on every ride from October 1, 2024. HCPF accepts no other log.
6. Receipt within 365 days of the date of service.

Bill only the code for the vehicle actually used and the level of service the member needed. A wheelchair van carrying a member whose provider has not certified wheelchair use in writing bills the mobility vehicle codes instead. The NEMT billing codes guide explains the national code set.

January 1, 2027: MediDrive pays every trip

HCPF is moving the whole state to a single broker. The key dates:

After January 1, 2027, a provider not contracted with MediDrive cannot perform or be paid for Health First Colorado NEMT trips. Trips run outside the metro broker area before that date can still be billed to HCPF directly, as long as each claim arrives within the 365-day limit. HCPF says MediDrive pays for completed and verified invoiced trips every two weeks, and that your earlier Medicaid billing process may not carry over.

A few setup details affect payment. Your MediDrive contract has to carry the same legal business name and NPI or Medicaid ID as your Health First Colorado enrollment, so a dba name will not match. Each driver or vehicle needs one compatible device running MediDrive’s trip software, which the provider supplies. New companies enroll with HCPF first, complete credentialing through ProCredEx, and only then enroll with MediDrive. The MediDrive broker guide and the Colorado state guide cover enrollment in detail.

Trip records are getting stricter too. House Bill 26-1328, in effect since July 1, 2026, directs HCPF to require digital dispatch software from providers, the broker, or both. The software has to record each trip automatically: where and when the rider was picked up and dropped off, GPS coordinates, the route and mileage, and which driver and vehicle ran it.

A worked example

Here is a hypothetical 12-mile one-way trip outside the metro broker area, compared at July 2025 and July 2026 rates.

The wheelchair trip lost about 6 percent. The ambulatory trip lost about 38 percent, and the base rate now covers less than the mileage on anything longer than about four and a half miles. Fleets that run mostly ambulatory Medicaid work in Colorado should reprice routes with those numbers before signing a MediDrive agreement.

Pricing and invoicing in HealthRide

When one payer cuts a rate, the rest of your book has to carry more of the fleet’s cost. HealthRide invoicing prices each completed trip from that payer’s rates, and one ledger ties every payment to its invoice and trip. That makes it plain what each payer brings in after the July changes, and which private-pay and facility work has to make up the difference.