How to price NEMT trips: build rates from your real cost per trip

Use the structure payers already use

The simplest NEMT price has two parts: a base rate for each one-way trip and a rate for each loaded mile. Medicaid fee schedules use the same shape, so pricing this way makes your quotes easy to compare with what Medicaid pays.

On top of the two parts, price lists often add a few charges:

• Service level. Ambulatory, wheelchair, and stretcher trips each get their own base rate. Colorado’s 2026 schedule, for example, pays $12.15 for a mobility van trip, $34.14 for a wheelchair van, and $49.42 for a stretcher van.
• Waiting time. Charged in time units after a grace period. The national T2007 code bills waiting in half-hour increments.
• Attendants and extra help. A second person for stairs, heavy equipment, or a rider who cannot be left alone.
• After-hours and holidays. Medi-Cal pays $26.43 instead of $20.30 for a wheelchair van trip at night.
• Cancellations and no-shows. For private riders, under a written policy.

Some payers use other structures. Texas pays a flat rate per trip, and Indiana pays taxis by distance band (0 to 5 miles, 6 to 10, and 11 or more). Know which structure each payer expects before you quote.

Work out your real cost per trip

A price that does not cover cost loses money on every ride. Start with what one vehicle costs to run for a day, then divide it between trips and miles. Use your own numbers. The example below is a placeholder to show the math, not a benchmark.

Example: one wheelchair van runs a 10-hour day with 12 one-way trips, 110 loaded miles, and 60 empty miles between trips.

Now split the day into the two parts of your price:

1. Per-mile cost. Fuel and maintenance for all 170 miles, divided by the 110 loaded miles, is about $0.70 per loaded mile. The empty miles are included because riders do not pay for them any other way.
2. Per-trip cost. Driver, vehicle, and overhead ($370) divided by 12 trips is about $30.83 per trip.

So this van breaks even at roughly $30.83 per trip plus $0.70 per loaded mile. Add your margin on top. The same math with more trips per day drops the per-trip cost fast, which is why deadhead miles and routing matter as much as the price itself.

The IRS 2026 business mileage rate of 72.5 cents a mile, which reflects IRS cost data for operating a vehicle, is a rough check on what an ordinary car or van costs to run. A lift-equipped van usually costs more to buy, insure, and maintain.

Check your price against Medicaid rates

Your state’s Medicaid fee schedule is the most public price benchmark you have. It is not what you have to charge private riders, but it tells you what Medicaid pays for the same trip. Our Medicaid NEMT rates by state guide lists 2026 rates for nine states.

Two Medicaid rules affect your private prices directly:

• Medicaid pays the lower of your charge or its rate. North Dakota pays the lesser of your usual and customary charge or its calculated rate. If your usual charge is below the fee schedule, you leave money on the table.
• Your private discounts can follow you. North Dakota says a provider cannot charge Medicaid more than it charges non-Medicaid riders, and a discount given to non-Medicaid riders must also be given to members. Colorado says submitted charges cannot exceed what you charge riders outside Health First Colorado.

If you serve both Medicaid and private riders, set one published price list and apply it consistently.

Price the extras, and write them down

Extras are where private-pay pricing is won or lost. Decide each one before the first phone call:

• Wait time. Set a grace period and a charge per half hour after it. Medicaid programs that pay waiting use similar units: Medi-Cal pays $11.30 per half hour for up to 90 minutes.
• No-shows and late cancellations. For private riders, set a fee and a cutoff time in a written policy. For Medicaid riders, follow your state manual. CMS guidance says states and providers may not charge a beneficiary for a no-show, while North Dakota’s manual allows it under a policy applied equally to every rider and posted or given in writing. Our no-show policy template is a starting point.
• Stairs and extra assistance. A stair chair or a second attendant takes time and a second person. Price it as a flat add-on.
• Long distance. A trip far outside your service area often means an empty return and a van that cannot take other work. Quote the return miles and the driver’s time.
• Rural trips. Longer empty drives raise the cost of each rural ride. Minnesota’s Medicaid rates, for example, pay 125 percent of the mileage rate on rural trips of 17 miles or less.
• After hours. Nights, weekends, and holidays cost more to staff. Charge more for them.

Put all of it on one rate sheet you can hand to a family or a facility. A clear written price avoids arguments at drop-off.

Pricing for facilities and repeat riders

Facilities and standing-order riders are worth a separate price sheet. A dialysis rider three times a week is about 150 round trips a year, and a senior living community can send several rides a day. Three choices matter:

• Contract rates or list rates. A facility may ask for a discount in exchange for volume. Put the rate, the service levels it covers, and the extras in a signed agreement, and remember the usual and customary rule if you also bill Medicaid.
• Zone pricing. A flat price for trips inside a set radius is easy for a facility to budget. Indiana’s Medicaid taxi bands (0 to 5, 6 to 10, and 11 or more miles) are one model.
• Invoice terms. Decide when invoices go out, when they are due, and what happens when they are late. Monthly invoicing with net 30 terms is simple for facility billing offices to process.

Our guides on facility contracts and standing orders cover how to win and schedule that work.

Keep prices current

Costs move, and your prices should follow. Recalculate your cost per trip when fuel, insurance, or wages change, and at least once a year.

Minnesota’s Medicaid program shows one way to handle fuel. In any quarter when gasoline tops $3.00 a gallon, its statute raises the per-mile rate 1 percent for every 10 cents above $3.00. A private fleet can write a similar fuel adjustment into facility contracts so a fuel spike does not erase the margin.

The trip price calculator runs a quote from your base rate, mileage rate, and extras. The private pay guide covers deposits, cards on file, and facility invoicing.

Quoting and collecting in one place

A price only helps if every dispatcher quotes it the same way. In HealthRide, prices come from your rate schedules, set per payer, and each trip is quoted at booking. Private riders can pay by card on file or payment link, and every payment lands in one ledger matched to its trip.