NEMT billing codes: every HCPCS code and modifier transportation providers use

How NEMT billing codes work

Every NEMT claim line carries a HCPCS Level II code. HCPCS is the national code set CMS maintains for services, supplies, and transportation that CPT codes do not cover. CMS updates the file every quarter. The October 2026 file shows no change to any NEMT code, so the list below is current.

Most trips are billed as two lines:

1. A base code for the one-way trip at the service level the rider needs, such as a wheelchair van or stretcher van.
2. A mileage code for the loaded miles on that trip, billed in units of one mile.

Escorts, waiting time, tolls, and meals and lodging go on their own lines when your program pays for them.

Two facts shape everything else:

• Medicare pays none of these codes. In the CMS file, every NEMT code in the tables below carries coverage code I, “Not payable by Medicare.” The S codes also carry a CMS note that they were created for private payer use. Medicare covers ambulance transport, which has its own codes. See does Medicare cover NEMT for the details.
• Each state decides which codes it accepts. The descriptions are national. The choice of codes, units, modifiers, and rates belongs to your state Medicaid program, your managed care plan, or your broker.

The NEMT HCPCS codes

The descriptions below are the official long descriptors from the CMS October 2026 HCPCS file. Each code links to its own glossary page with more detail.

Trip and base codes

Mileage codes

Escort, waiting time, and travel costs

A0170 through A0210 are covered together on the NEMT ancillary codes page.

Origin and destination modifiers

Origin and destination modifiers tell the payer where a trip started and ended. They come from Medicare’s ambulance rules in Chapter 15 of the Medicare Claims Processing Manual, and many Medicaid programs apply them to NEMT. Each letter stands for a place. Two letters combine into one modifier: the first is the origin and the second is the destination.

A dialysis rider picked up at home and taken to a freestanding dialysis center is RJ. The ride home is JR. A home-to-doctor trip is RP, and the return is PR. The origin and destination modifiers page lists more combinations.

States use these letters differently:

• Indiana requires both letters on the base code and the mileage code of every trip.
• Nevada’s NEMT encounter guide allows a shorter list (D, E, H, J, N, P, R) and uses U1 and U2 instead for pharmacy trips out and back.
• Oregon tells providers to enter the pair as one two-digit modifier, never as two separate one-letter modifiers.
• Ohio publishes the pairs wheelchair van codes can carry without manual review and adds its own letters, such as U4 for a workplace and U7 for a school.
• Colorado’s NEMT manual does not call for origin and destination modifiers.

Other modifiers you will see

Beyond origin and destination, NEMT claims pick up a handful of other modifiers. Their national descriptions are broad, and states assign them narrow meanings.

The same situation can need different modifiers in neighboring states. A second same-day trip is modifier 76 in Colorado. Indiana told providers in bulletin BT2025119 (August 19, 2025) to stop using 76 for that and use XE instead.

How states code the same trip differently

The table shows how a few programs code their most common trips. It uses each state’s current fee-for-service manual or fee schedule.

Texas’s Medical Transportation Program handbook tells demand response providers to bill T2003 with modifier U1, U2, or U3, and each modifier carries its own rate. Minnesota pays by the rider’s assessed mode rather than the vehicle that shows up. For the dollar amounts behind these codes, see how much Medicaid pays for NEMT.

Coding mistakes that cost money

Most coding denials trace back to a few habits:

• Using a national code a state no longer accepts. Colorado dropped A0425 for non-ambulance mileage for trips on or after July 1, 2025. Indiana treats S0215 as nonreimbursable and wants A0425 with a U modifier.
• Billing the vehicle instead of the level of need. Colorado only pays wheelchair van codes when the rider’s medical professional has stated in writing that the rider is wheelchair confined. Without that statement, a wheelchair van trip is billed with the mobility vehicle codes.
• Splitting mileage. Indiana requires round-trip mileage on one line and bans fragmented mileage.
• Rounding miles the wrong way. Colorado accepts whole units only. Indiana rounds 15.5 miles up to 16 and 15.4 miles down to 15.
• Missing modifiers. Where a state requires origin and destination modifiers, a line without them can deny outright.

When a line does deny, the reason code on the payment report tells you which rule you broke. Our guide to NEMT claim denials explains how to read those codes. The CMS-1500 guide shows where each code and modifier goes on the form.

Keeping trip details on record

Every code and modifier depends on facts from the trip itself: the service level, the pickup and drop-off addresses, and the loaded miles. In HealthRide, each trip leg keeps its service level, addresses, times, and GPS-recorded miles, and the trip log report exports them as a spreadsheet or PDF. When a payer questions a line, the record of the ride is already there.