Wisconsin SMV rates: the ForwardHealth fee schedule for nursing home trips and the NEMT manager

Two ways an SMV trip gets paid in Wisconsin

For most Medicaid and BadgerCare Plus members, specialized medical vehicle (SMV) trips are arranged and paid by the NEMT manager, MTM, Inc. The ForwardHealth NEMT handbook says SMV providers must contract with the manager and send their claims to it to be paid for those rides. On manager trips, your MTM agreement sets the pay.

The ForwardHealth SMV maximum fees apply when an SMV company bills ForwardHealth directly, which happens for members outside the manager system. The NEMT handbook names two such groups:

• People living in a nursing home who are not receiving hospice. The nursing home arranges their rides. HMO members and dual Medicare-Medicaid members can be exceptions.
• Members of Family Care, Family Care Partnership, or PACE. Their managed care organization arranges their rides, so its own arrangements, not the state schedule, decide the pay.

SMV trips billed to ForwardHealth follow the SMV handbook: a Certification of Need on file, the trip ticket, the modifiers, and the maximum fees below. The Wisconsin state guide covers SMV certification, the WisDOT inspection, and insurance, and the specialized medical vehicle entry explains the provider type.

The SMV maximum fees

ForwardHealth’s interactive fee search lists the SMV amounts below for an October 1, 2026 date of service, each with an effective date of January 1, 2022. The standard column is the first or only member on a trip; the extra member column is the multiple carry rate billed with modifier TK.

Payment is the lower of your billed amount and the maximum fee. ForwardHealth expects each provider to bill its usual and customary charge, meaning the price it gives people who are not on Medicaid, and warns against setting prices from the schedule. See usual and customary charge for how that rule works across programs.

Two cautions on looking these up. A 2008 PDF of the SMV schedule still sits on ForwardHealth’s site and lists the older amounts of $11.99 for the base and $1.26 a mile. The interactive search shows the current figures, and since September 13, 2026 it can return up to 20 years of past schedules. ForwardHealth stops offering downloadable fee schedules on February 1, 2027, so the interactive search will be the only place to check.

What the base rate buys

The A0130 base pays for three things together:

1. Sending the van to the member’s pickup point.
2. Escorting the member to and from the door at both ends.
3. The first five miles, counted from the pickup point.

Bill the base as one unit. Mileage on S0209 starts after mile five and goes on the claim in tenths of a mile, so 14.3 loaded miles becomes 9.3 units of S0209. A trip runs from pickup to the destination, and only the shortest, most direct route is covered. Helping a member inside the building at either end earns nothing extra.

Unloaded miles over 20

Empty miles to reach a member are paid only past a 20-mile threshold: the van has to cover over 20 miles on the shortest route from its dispatch point. DHS 107.23(1)(c)5 sets the rule, and it also requires that no other passenger be aboard on the way. The handbook adds how to bill it:

• Record every unloaded mile on the Specialized Medical Vehicle Transportation Trip Ticket/Medical Care Verification (F-01050), but bill only the miles past 20. A 35-mile empty run is billed as 15 miles.
• Use S0209 with modifier TP for a wheelchair van, or T2049 with TP for a stretcher van.
• Unloaded miles are paid once per trip, even when the van picks up several members.
• The empty drive back to the garage is never paid.

At the maximum fee, the four billable miles on a 24-mile empty run come to $1.92.

Waiting time against a second base rate

A van that waits at the clinic bills waiting time on A0170 instead of a new base rate for the ride home. The handbook’s rules:

• Waiting is billed in fractions of an hour. One hour and 40 minutes is 1.7 units.
• The cap is six hours per member per date of service.
• Only one member’s waiting time is paid, even if the driver waits for several members at one place.
• Waiting pays only when there is both a trip to the appointment and a trip back, and no second base rate is billed for the return.
• The driver must physically wait at the location and may not run other trips during that time. The start and end times of the wait go on the trip ticket.

Two hours of waiting pays $9.70, less than one $12.59 base, and the van can earn nothing else in that time. A wait would have to pass about 2.6 hours before the waiting line alone matched a second base rate.

Here is a hypothetical outbound trip built from the handbook’s own example: the van drives 24 miles empty to the member, carries the member 20 miles to a clinic, and waits two hours.

The ride home goes on the claim as mileage only, on S0209 with the U2 trip modifier, with no second base rate because waiting time was billed.

Modifiers every SMV line needs

Each procedure code on an SMV claim needs a trip number modifier, and some trips need more:

• U1 to U6. Trip number modifiers tie each line to the first through sixth trip for the same member, by the same provider, on the same date.
• TK. Marks each extra member on a multiple carry trip. Only one member is billed at the standard rate, and when the members go to different destinations by direct routes, you may bill the member with the most total mileage at the standard rate. The trip ticket names the primary rider.
• TP. Marks unloaded mileage on S0209 or T2049.
• HR and NR. Mark a hospital discharge or a nursing home discharge. These claims do not need a referring physician’s provider number or a prior authorization number, whatever the mileage.

Every claim also carries a place of service code for the destination, such as 12 for home, 11 for an office, 31 for a skilled nursing facility, or 32 for a nursing facility. The place of service code entry covers how these work on transportation claims.

The Certification of Need on file

Every SMV trip billed to ForwardHealth needs a completed Certification of Need for Specialized Medical Vehicle Transportation (F-01197), including nursing home and hospital discharges. The member is responsible for giving you a copy, but you are the one who loses the payment without it.

• Who signs. The member’s physician, nurse practitioner, physician assistant, or nurse midwife.
• When it must be filed. In the member’s file within 14 working days after it is signed, and before any claim goes out.
• Phone approvals. If the medical provider approves by phone, get the completed form within 10 working days of the approval or before you bill, whichever comes first.
• Temporary disabilities. The form is valid for no more than 90 days from the signature.
• Legally blind or indefinitely disabled members. DHS 107.23 says the documentation is rewritten every year, while the current handbook says every 36 months. Renewing each year meets both.

Stretcher trips need more. The handbook allows them when a physician, physician assistant, nurse practitioner, nurse midwife, or registered nurse prescribes cot or stretcher transport, and a fastener assembly locks the cot to the vehicle’s side wall and floor during the ride.

Trips that need prior authorization

DHS 107.23(2)(f) requires prior authorization for SMV trips over 40 miles one way from the member’s residence in Brown, Dane, Fond du Lac, Kenosha, La Crosse, Manitowoc, Milwaukee, Outagamie, Sheboygan, Racine, Rock, and Winnebago counties. Everywhere else, 70 miles one way applies. An out-of-state service that already has prior authorization is an exception. Hospital and nursing home discharges billed with HR or NR do not need a prior authorization number regardless of distance.

What ForwardHealth will not pay

The SMV handbook’s list of services with no reimbursement includes several that catch new providers:

• Any SMV service without a valid, completed Certification of Need.
• Charges when a member fails to cancel, and extra charges for nights, weekends, or holidays.
• Unloaded miles when the dispatch point is 20 miles or less from the first pickup.
• Excess mileage from indirect routes, and trips past the mileage limits without prior authorization.
• Riding relatives, friends, or attendants, and trips to a pharmacy to pick up prescriptions or supplies.
• Sales tax.

The handbook also refuses payment through a factor, which is any company or person that buys your receivables or advances money against them. Billing services that bill and receive payment in your name are allowed. SMV providers must also request a $1 copay from the member on every transport where a base rate is billed. Nursing home residents, children under 19, hospice patients, and several other groups are exempt.

Manager trips: MTM now, Verida next

For trips the manager arranges, MTM sets each transportation company’s rates in individual talks and pays by direct deposit every week. It pays nothing for a member no-show. Its insurance floor is $1,000,000 per policy, combined single limit, covering general liability and again auto liability. MTM must appear on the policy in two roles: certificate holder and additional insured. The MTM Health broker guide covers how MTM works with providers elsewhere.

The manager is changing. DHS gave notice on May 21, 2026 that it plans to award the contract to Verida, Inc., the top scorer among the bidders for RFP S-1699 DMS-25. Until the switch, MTM stays under contract. As of the August 25, 2026 page update, DHS had set no switchover date and asked nothing new of transportation companies. The Verida guide tracks that company’s networks.

Keeping SMV trip tickets complete in HealthRide

The SMV trip ticket holds the details ForwardHealth looks for behind a claim: unloaded miles, the primary rider on a multiple carry trip, when any wait began and ended, and a signed verification of the medical visit. From the driver app, HealthRide captures signatures on screen and time-stamps each pickup and drop-off. Each leg’s GPS-recorded miles, driver, and vehicle go into the trip log you can export from reports, so the miles on a ticket can be checked against what the van drove.