Hospice transportation: serving hospice agencies and their patients

Why the hospice agency pays for the ride

Hospice changes who pays for transportation. A patient who elects hospice chooses comfort care instead of treatment to cure the illness, and one agency takes responsibility for all care related to the terminal illness. Medicare pays that agency a daily rate per patient, set by level of care, under 42 CFR 418.302, and the agency covers the related services out of it.

Medicare’s rule for ambulance trips is spelled out in Chapter 9 of the Benefit Policy Manual: ambulance transports related to the terminal illness that happen after the effective date of the election are the responsibility of the hospice. The manual gives an example. A patient’s condition worsens, the hospice adds an inpatient stay to the plan of care, and it decides the patient needs an ambulance to the hospital. That ride becomes a covered hospice service.

Two exceptions matter to anyone who drives these patients:

• The ride home on day one. An ambulance transport to the patient’s home on the effective date of the election is paid by Medicare’s ambulance benefit, not the hospice. The plan of care does not exist yet, because the initial assessment happens where the patient will receive care.
• Unrelated care. Services unrelated to the terminal illness can be billed outside hospice. On professional claims they carry the GW modifier, “service not related to the hospice patient’s terminal condition,” under the Claims Processing Manual.

Medicare.gov tells patients the same thing from their side: once hospice starts, Medicare will not cover ambulance transportation unless the hospice team arranged it or it is unrelated to the terminal illness.

State Medicaid rules for non-emergency rides

Medicare’s manual speaks to ambulances. Some state Medicaid rules go further and put non-emergency rides on the hospice too. Two examples:

Each state writes its own hospice policy, so check yours before quoting a hospice. The practical point in both states is the same: a related ride is the agency’s cost, and an unrelated ride goes to the program that would have paid for it anyway.

Some rides fall outside hospice and Medicaid alike. A personal outing, such as a trip to a family event, is not among the hospice services listed in 42 CFR 418.202, and Medicaid pays only for travel to medical examinations and treatment (42 CFR 440.170). Quote those as private-pay trips unless the hospice agrees in writing to pay.

Medicare Advantage does not change who pays. Medicare.gov says Original Medicare covers everything related to the terminal illness once hospice starts, even if the patient keeps a Medicare Advantage plan, and MedPAC’s March 2026 report confirms that fee-for-service Medicare pays for hospice for both groups. The plan’s transportation vendor is not the payer for related rides.

The trips hospices need

Hospice care usually happens where the patient lives: at home, in an assisted living facility, or in a nursing home. The rides below follow changes in the level or place of care, plus appointments in the plan of care.

Respite has a fixed shape worth planning around. The Benefit Policy Manual pays the respite rate for no more than 5 consecutive days at a time, and patients who already live in a facility such as a nursing home cannot receive respite care. Respite rides therefore serve patients who live at home rather than in a nursing home, and the paid stay of five days or less sets the likely date of the return trip.

A company with stretcher capacity, trained two-person crews where the state requires them, and room for a family member can take trips that a wheelchair-only fleet cannot. Our guide to starting a stretcher transportation business covers the state rules and equipment.

What a hospice contract should say

A hospice that buys transportation has to manage it. 42 CFR 418.100(e) says a hospice using another organization under arrangement keeps administrative and financial management and oversight of the arranged services, and the written agreement must require that services be:

1. Authorized by the hospice.
2. Furnished safely by qualified personnel.
3. Delivered according to the patient’s plan of care.

That translates into contract terms a transportation company should ask for:

• Who can order a ride. Name the hospice staff roles that can authorize trips, so a family member calling in cannot commit the agency to pay.
• Related or unrelated, per trip. The hospice marks each ride as related to the terminal illness or not. Related rides go on the hospice invoice. Unrelated rides go to Medicaid, another payer, or private pay.
• Service levels and crew. Wheelchair, stretcher, oxygen, and how many crew members for each.
• Response times. Scheduled trips and short-notice transfers to inpatient care need different commitments.
• Condition changes. Agree in writing on what the crew does if the patient declines during the ride, and who they call first.
• Rates and invoicing. Per-trip or per-mile prices, wait time, after-hours fees, and a monthly invoice with trip-level detail.

Our facility transportation agreement template is a starting point for these terms.

Serving hospice patients well

Hospice rides carry more weight than most trips. The rider may be making one of their last journeys, and the family is often in the vehicle.

• Take time at the door. A rider moving from bed to stretcher and out through the home needs a crew that is not rushing. Book enough time for it.
• Keep the family informed. A call when the crew is on the way, and a clear plan for who rides along, prevents confusion at pickup.
• Brief the crew. Before the trip, drivers should know the service level, the equipment needed, and whom to call at the hospice.
• Protect privacy. A hospice diagnosis is sensitive health information. Share only what the crew needs to do the trip.

How to win hospice work

1. List the hospices in your area. CMS’s Hospice General Information dataset covers every Medicare-certified hospice, with the address and phone for each. MedPAC counted 6,706 hospices serving Medicare patients in 2024.
2. Call the right person. Ask for the director of nursing, the administrator, or whoever schedules patient transfers.
3. Lead with coverage they can count on. Stretcher capacity, short-notice inpatient transfers, and weekend availability.
4. Show you understand the payer split. Explain how you separate related and unrelated rides so the hospice never pays for a trip it should not.
5. Offer clean monthly billing. Hospices manage costs against a daily rate, so an invoice that lists each trip, date, patient, and service level makes approval easy. Our guide to NEMT facility billing covers invoice setup.

Hospice work fits well alongside other facility accounts. The sales approach is the same one laid out in how to get NEMT facility contracts.

Billing hospices in HealthRide

HealthRide turns each hospice’s completed trips into an invoice priced from that agency’s rates, and you review it before it goes out. Every invoice carries its status, from outstanding to paid or past due, so month-end billing for every hospice account takes minutes. When Ryder Go plans the day, it puts each rider with wheelchair, stretcher, or oxygen needs on a vehicle equipped for them.