Ohio Medicaid wheelchair van and NEMT rates: fee-for-service maximums and plan trips

Three payers for one kind of ride

An Ohio Medicaid ride is paid one of three ways, and the rate depends entirely on which one applies.

OAC 5160-15-21 limits who can bill ODM for transportation to wheelchair van providers, ambulance providers, hospitals, and providers under contract with a managed care plan. A sedan company that drives under a county contract is a vendor to the county, and the rules say it is not a Medicaid transportation provider at all. So the only published Ohio NEMT rate schedule is really a wheelchair van and ambulance schedule. The Ohio state guide covers licensing, enrollment, and each plan’s vendor in more depth.

ODM’s wheelchair van maximums

On a fee-for-service claim, ODM pays whichever is lower: the amount you bill, or the maximum in force on the trip date. The maximums sit in the appendix to OAC 5160-15-28. The current version of that appendix was enacted July 10, 2026, and the rule itself took effect August 1, 2026, but the wheelchair van amounts did not move.

That date lines up with ODM’s broad provider rate increase. CareSource’s January 2024 notice to Ohio providers listed transportation among the non-institutional services whose new ODM rates applied to services from January 1, 2024 onward, paid by when the service happened rather than when it was billed.

Companies that also run ambulances can compare the non-emergency ambulance lines on the same appendix: basic life support non-emergency (A0428) at $203.75, ground mileage (A0425) at $5.05 a mile, and an extra ambulance attendant (A0424) at $18.00. The appendix has no stretcher van code.

Modifiers that decide whether the claim pays

Every wheelchair van claim carries an origin and destination. Ohio recognizes twelve points of transport in OAC 5160-15-25: the ten CMS locations plus a workplace and a school.

The appendix spells out which origin and destination combinations clear without manual review. Any other pair goes to manual review, and so does U5, the code for a place not otherwise specified. A manual review request needs the practitioner certification form, a full description of the service with date, origin, and destination, any special services, the reason for an attendant, and any circumstances ODM should weigh. The origin and destination modifiers entry explains how the pairs are built.

Four information modifiers also apply to wheelchair van codes:

• U3 marks a wheelchair van service delivered in an ambulance, and is used only with A0130, S0209, and T2001.
• U6 means the medical service was unavailable when the vehicle arrived.
• UA flags a repeat: the rider’s second ride that day, in a vehicle of the same kind, to or from a location of the same kind.
• UB flags the third such ride that day.

When a wheelchair van trip qualifies

OAC 5160-15-22 ties wheelchair van payment to the rider’s mobility device. The device has to come along for the whole trip, and the rider has to sit in or on it while moving between the van and the place of care. A standard passenger vehicle must also be out of the question. Relying only on a cane, crutch, or walker is not enough. Ohio’s definition of a mobility device covers manual and power wheelchairs, scooters, and wheelbenches.

A few more conditions follow from the same rule and from OAC 5160-15-26:

• The ride serves a Medicaid-covered service, and both ends are recognized points of transport.
• An attendant is billed only when the rider cannot travel safely without one, and the reason stays in your file. Ohio defines an attendant as your employee, riding in addition to the minimum crew.
• Wheelchair van service is never medical treatment. If you expect to give treatment en route, no part of the trip can be billed as a wheelchair van trip.
• A company enrolled for both wheelchair van and ambulance service may send an ambulance on a wheelchair van trip with the U3 modifier, but only if no wheelchair van was available. The rule allows three reasons: the scheduled van broke down or was delayed, your vans cannot fit the rider’s device, or an ambulance was requested and the crew found on arrival that a wheelchair van was enough.

What ODM does not pay for

OAC 5160-15-26 lists the gaps. Price private and facility work knowing these never come back from ODM:

• Miles to reach the rider or to leave after drop-off. Those count as part of the trip, and the rider cannot be billed for them either.
• Any leg driven without a Medicaid member aboard.
• Extra miles from a roundabout route, and non-emergency mileage beyond 50 miles from the pickup when nothing in your records justifies it.
• Other passengers, apart from the rider and one attendant.
• Hospital staff acting as attendants, and one attendant billed for several riders at once.
• Trips for people who lacked Medicaid eligibility when the ride took place, or to services their benefit package does not cover.

When two or more Medicaid riders share part of a trip, ODM wants the shared miles divided among them by a method that is sensible and applied the same way every time. The canceled-appointment exception works in your favor: if no one warned you and you did not cause the cancellation, you can bill the transport and actual loaded miles once you collect the medical provider’s signed statement described in the rule.

Certification forms and trip records

For fee-for-service wheelchair van trips, a practitioner certifies the need on form ODM 03452, Certification of Necessity for Transportation by Wheelchair Van. OAC 5160-15-27 sets the rules:

1. Get the completed, signed, dated form before you submit the claim.
2. The practitioner must sign within 180 days of the first date of service or of the day you found out the rider had Medicaid, whichever is later. A late signature never extends the timely filing limit.
3. The practitioner sets the length: temporary, for 90 days at most, or ongoing, for one year.
4. Nobody employed by or associated with your company can sign it.
5. If the practitioner never answers, you may bill after three attempts spaced at least 30 calendar days apart.

Managed care plans are not bound to use this form for their members. Your own records must hold current credentials for crew and attendants, the certification forms, any manual review requests, the trip information required by the ambulette rules in agency 4766, the vehicle used, each attendant’s name, each rider’s Medicaid number, and a signature from every rider on non-emergency trips. The NEMT documentation guide turns lists like this into a daily routine.

Filing fee-for-service claims

OAC 5160-1-19 says ODM does not take paper claims unless it directs otherwise. Claims go through electronic data interchange or the ODM provider web portal. The filing window runs 365 days from the service date, counted to the day ODM receives the claim, and a resubmitted denied claim gets no extra time. Two common exceptions accept a late claim if ODM receives it within 180 days of a later event: a delayed eligibility determination or state hearing decision (counted from the notice), and a third party reversing its payment (counted from the recovery of funds). The timely filing limit entry compares Ohio with other states.

County NET contracts

For fee-for-service riders not traveling by wheelchair van, the county arranges the trip. OAC 5160-15-10 tells each CDJFS to choose the cheapest option suited to the rider that still gets them to care on time. Its menu includes contracted livery service, paid transit rides, fuel vouchers, prepaid fares, mileage reimbursement, and rides in county vehicles. A county may decline a request when the rider’s plan is obliged to provide the ride.

A company that drives for a county is a private transportation vendor under OAC 5160-15-14. When the contract starts or renews, and whenever you consider hiring a driver or other direct-service employee, the rule requires that each driver hold a valid license, that the county receive the driver’s certified BMV record, a background check under ORC 109.572, and searches of the federal SAM and LEIE exclusion lists. The county then reports the results to ODM within 30 calendar days.

Pay is whatever the county contract says. Hamilton County’s December 2025 request for proposals shows how that works in a large county: each bidder submits a budget and a unit rate for a two-year term with two optional two-year renewals, profit for a for-profit bidder is negotiated separately, and the county states that its funding does not reimburse no-shows or canceled trips. Read each county’s bid before you price it.

Plan vendor contracts

For managed care members, OAC 5160-15-28 says payment follows your agreement with the plan, not the appendix. Each plan hires a vendor. Anthem Blue Cross and Blue Shield members book through MTM Health, and Buckeye Health Plan’s program runs through SafeRide Health, to name two.

ODM’s July 2026 plan contract sets service standards that shape how you schedule, even though it leaves the rate to your contract:

• The plan must provide a ride whenever the member travels 30 miles or more each way to a covered service.
• It cannot demand more than 48 hours’ notice, and it must make exceptions for urgent trips and hospital discharges.
• Pickup has to land within 15 minutes, early or late, of the scheduled time. It can never come more than half an hour after the time the member asked for. The vendor may not pull away before the scheduled time and must try to reach a member who is not there.
• On a shared ride, no member may spend more than 60 minutes beyond their direct travel time.
• The plan cannot cap the number of rides in a day.

Because vendor rates are negotiated, the ODM appendix is a benchmark to hold up against a vendor’s rate sheet, not a number any vendor must pay.

GPS verification is on the way

Senate Bill 315, effective October 6, 2026, directs ODM to adopt a GPS-based verification system for non-emergency transportation. The system logs arrival at the pickup, the start of the ride, arrival at the destination, and the end of the ride, along with timestamps, route, and total distance. ODM must deliver a plan within six months, start a pilot within twelve, and require every covered provider to use the system within eighteen months. Once the system is fully in place, a covered provider is paid only when all required GPS and timestamp data are present and no discrepancy is open. ODM must set up a written exemption process for equipment or network failure (rural dead zones included), emergencies, and rider safety.

The law’s definition leaves out transport by licensed emergency and nonemergency medical service organizations, so licensed ambulette services sit outside it. Companies that drive under county contracts or plan vendors without that license should expect the requirement.

A worked example

A hypothetical fee-for-service wheelchair van round trip, 12 loaded miles each way, with a documented attendant, billed at or above the ODM maximums:

Stretch the same trip to 65 miles each way and, without extra documentation, mileage stops at 50 miles, or $65.00 a leg. For code definitions, see the NEMT billing codes guide. For other states’ figures, see how much Medicaid pays for NEMT.

Keeping Ohio trip records in HealthRide

Ohio pays on details the driver records: loaded miles, times, signatures, and who rode along. In HealthRide’s reports, the trip log shows every leg with where it started and ended, when, the driver, the vehicle, and GPS-recorded miles, and it exports to a spreadsheet or a print-ready PDF. The payer summary keeps county, plan, and private work apart, with completed trips, amounts billed, and open balances for each.