NEMT glossary
The words, codes, and abbreviations you run into in non-emergency medical transportation, each explained in plain English with how it plays out on a real day.
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Billing codes
27 terms
- A0080A0080 pays per-mile mileage when a volunteer with no vested interest drives a Medicaid member. The official descriptor, units, and 2026 state rates.
- A0090A0090 pays mileage when a family member, neighbor, or the member drives to a Medicaid appointment. The descriptor, units, and how four states use it in 2026.
- A0100A0100 is the HCPCS code for a non-emergency taxi ride. The descriptor, how units work, which mileage code pairs with it, and 2026 rates in four states.
- A0110A0110 is the HCPCS code for non-emergency bus transportation. How states use it for tickets and passes, what they pay, and the receipts they expect.
- A0120A0120 covers mini-bus, mountain area, and other transportation systems. How states use it for ambulatory vans, what they pay in 2026, and how to bill it.
- A0130A0130 is the HCPCS base code for a wheelchair van trip. The official descriptor, units, the mileage code it pairs with, and 2026 rates in four states.
- A0140A0140 covers non-emergency air travel on private or commercial flights. What it pays for, how states price tickets, and the prior approval rules in 2026.
- A0160A0160 pays per-mile mileage when a caseworker or social worker drives a Medicaid member. The official descriptor, who bills it, and how states pay in 2026.
- A0170 to A0210A0170 to A0210 are HCPCS codes for NEMT ancillary costs: tolls and parking, plus meals and lodging for member and escort. Descriptors and 2026 rates.
- A0425A0425 bills ground ambulance miles, one unit per loaded mile. How Medicare counts them, which Medicaid programs use it for vans, and 2026 state rates.
- A0428A0428 bills one non-emergency BLS ambulance trip. Crew, vehicle, and medical necessity rules, 2026 Medicaid rates, and why stretcher vans bill differently.
- Diagnosis codes on NEMT claimsSome Medicaid programs want an ICD-10 code on every ride claim. The defaults Colorado, Arizona, Indiana, North Carolina, and Texas use, and where Z59.82 fits.
- HCPCS Level IIHCPCS Level II is the CMS code set behind every ambulance and NEMT claim. How it differs from CPT, where the ride codes sit, and how quarterly updates work.
- NEMT billing unitsA billing unit is the count on each claim line: a trip, a mile, a half hour, or a day. How units work by code and how Medicare, Indiana, and Oregon round miles.
- Origin and destination modifiersOrigin and destination modifiers are letter pairs like RP or JR that show where a NEMT trip started and ended. Every letter and how states use them.
- Place of service codeNEMT claims usually carry place of service 41, 42, or 99 in box 24B. Which code Colorado, Oregon, North Carolina, Texas, and Medi-Cal want, and why.
- S0209S0209 is the per-mile code for wheelchair van mileage. The official descriptor, how it pairs with A0130, which miles count, and 2026 rates in four states.
- S0215S0215 is the general per-mile code for non-emergency transportation. Which trips it pairs with, how four states use it in 2026, and the mileage rules to follow.
- T2001T2001 bills a patient attendant or escort on a non-emergency trip. What it covers, how units differ by state, and 2026 rates from California to Illinois.
- T2002T2002 is the HCPCS code for non-emergency transportation billed per diem. What a per diem unit means, how it differs from T2003, and how states pay daily costs.
- T2003T2003 bills one non-emergency transportation encounter or trip. How Texas, Louisiana, Nevada, and Colorado use it in 2026, the modifiers, and the rates.
- T2004T2004 covers non-emergency transport on a commercial carrier with a multi-pass. How Colorado, Oregon, North Dakota, and New York use it and what it pays.
- T2005T2005 is the HCPCS base code for a non-emergency stretcher van trip. Who qualifies, how it pairs with T2049 mileage, and 2026 rates in five states.
- T2007T2007 bills waiting time for non-emergency vehicles in half-hour units. When states pay it, how many units they allow, and the documentation they want.
- T2049T2049 is the per-mile code for stretcher van mileage, billed next to T2005. The descriptor, which miles count, and 2026 rates compared with wheelchair miles.
- TK modifierTK marks an extra rider or companion on a non-ambulance trip. Who that person is in Indiana, Illinois, Colorado, and South Dakota, and the rate each state sets.
- U modifiersU1 to UD are HCPCS modifiers each state defines for itself. How Texas, Indiana, Colorado, Ohio, and Nevada use them on rides, and how to read your own list.
Billing and claims
13 terms
- CapitationCapitation pays a plan or broker a fixed sum per enrolled member each month, used or not. How it reaches NEMT brokers, and why it shapes provider rates.
- Claim adjustment reason codes (CARCs)CARCs are the standard codes that explain why a payer paid less than you billed. How group codes work, the CARCs NEMT providers see most, and remark codes.
- Clean claimA clean claim can be processed without asking anyone for more information. The federal Medicaid definition, the payment clock it starts, and NEMT examples.
- ClearinghouseHow a billing clearinghouse formats, checks, and routes electronic claims, what payers send back, whether a transportation company needs one, and HIPAA duties.
- Fee-for-service (FFS)In fee-for-service Medicaid, the state pays an enrolled transportation provider for each trip it bills, at fee schedule rates. How FFS NEMT billing works.
- Medicaid fee scheduleThe state price list that caps what fee-for-service Medicaid pays per code. Where transportation rates are posted, how to read them, and how broker pay differs.
- Mileage reimbursementNEMT mileage reimbursement pays riders, family, or friends per mile to drive to Medicaid care. 2026 rates and the rules in Texas, Missouri, and California.
- Prior authorizationPrior authorization is the payer's approval of a NEMT trip before it happens. When it is required, who grants it, and why unapproved trips often go unpaid.
- Taxonomy codeA taxonomy code tells payers what kind of provider you are. The NUCC transportation codes NEMT companies use, including 343900000X, and how states apply them.
- Third-party liability (TPL)Third-party liability means another payer owes before Medicaid does. What counts as a third party, how states enforce the order, and who a NEMT provider bills.
- Timely filing limitFederal rules cap Medicaid filing at 12 months, but states and brokers set far shorter deadlines. Real NEMT limits, the exceptions, and how resubmissions count.
- Trip authorization numberA trip authorization number is the ID a broker or state issues for an approved NEMT trip. Where it comes from, where it goes on a claim, and why it must match.
- Usual and customary chargeYour usual and customary charge is your normal public price. Why Medicaid claims carry it, how lesser-of payment works, and how private-pay prices count.
Brokers and Medicaid
17 terms
- Assurance of transportationThe assurance of transportation makes every state Medicaid plan ensure rides to covered care. What 42 CFR 431.53 guarantees riders and how states carry it out.
- ATMSIn NEMT, an ATMS is dispatch software a broker accepts for trip data, GPS, and billing. What it means, how New York and Colorado use it, and your options.
- CredentialingCredentialing is how a broker or plan checks a NEMT company, its drivers, and its vehicles before sending trips. What gets checked, and how it differs.
- Dual eligibleDual eligible riders have Medicare and Medicaid. Which program pays for their rides, where D-SNP benefits fit, and the order to bill when both apply.
- Dual special needs plan (D-SNP)A D-SNP is a Medicare Advantage plan for people with both Medicare and Medicaid. How its ride benefits work and how they sit beside Medicaid NEMT.
- EPSDT transportationEPSDT requires Medicaid to offer children under 21 help with rides and scheduling, including a parent's trip. What 42 CFR 441.62 means for providers.
- Least costly appropriate transportationMedicaid pays for the cheapest ride that still fits the rider's condition. How states and brokers apply the rule and how it shapes the trips you get.
- Managed care organization (MCO)A managed care organization is a health plan paid a fixed monthly rate per Medicaid member. How MCOs cover NEMT, hire brokers, and shape which fleets get trips.
- Medical necessity formA medical necessity form shows why a rider needs a wheelchair van, stretcher, or ambulance. Who signs it, how long it lasts, and real examples from four states.
- NEMTNEMT is Medicaid transportation to scheduled, non-emergency care for people with no other way to get there. The federal rules, who qualifies, and who pays.
- NEMT brokerA NEMT broker manages Medicaid rides for a state or health plan. It takes ride requests, credentials fleets, assigns trips, and pays providers. How it works.
- NEMT carve-outA NEMT carve-out keeps rides out of Medicaid health plan contracts, so a state broker or fee-for-service runs them. How it differs from a carve-in, by state.
- Non-medical transportation (NMT)Non-medical transportation means different things by program: waiver rides to jobs and day programs, or Medi-Cal rides to care. How NMT differs from NEMT.
- RecredentialingRecredentialing is the periodic re-check a broker or health plan runs on a NEMT provider already in its network. What gets rechecked and how often.
- Section 1115 waiverSection 1115 demonstrations let a state waive or reshape the Medicaid ride benefit for some groups. Current examples from Iowa, Georgia, and Hawaii.
- Transportation network company (TNC)A transportation network company arranges rides through an app. How Medicaid programs and brokers use TNCs for NEMT, the rules they follow, and their codes.
- Waiver transportationWaiver transportation is a Medicaid HCBS waiver service for rides to jobs, day programs, and community activities. How it is authorized, delivered, and billed.
Dispatch and operations
25 terms
- Advance noticeHow far ahead NEMT rides must be booked in Texas, North Carolina, Louisiana, and Vermont, the urgent and discharge exceptions, and broker timelines.
- Appointment timeIn NEMT the appointment time is the arrive-by deadline and the pickup time is worked back from it. Early-arrival limits by state, return timing, and an example.
- Deadhead milesDeadhead miles are the miles a NEMT vehicle drives with no rider on board. Why Medicaid does not pay for them, plus a worked example of what they cost.
- Dialysis chair timeDialysis chair time is a patient's fixed treatment slot at a dialysis center, usually three days a week for about four hours. What it means for NEMT rides.
- Dry runA dry run is a NEMT trip where the vehicle reaches the pickup and leaves empty. Common causes, why Medicaid does not pay, and how to document one.
- GeofenceA geofence is a virtual boundary around a pickup or drop-off that notes when a van arrives or leaves. How it works in NEMT, its accuracy limits, and data rules.
- Late cancellationA late cancellation is a NEMT ride cancelled after the notice deadline, often with the van already on its way. Deadlines by program and how to handle one.
- Loaded milesLoaded miles are the miles driven with the rider on board, and the only miles Medicaid pays NEMT providers for. How three states measure and bill them.
- Maximum ride timeMaximum ride time limits how long a NEMT rider stays in the van: direct time plus 45 or 60 minutes, New York's one-hour standard, and the effect on grouping.
- Missed tripA missed trip is a scheduled NEMT ride the provider never ran. How programs define it, the 0.25 percent limits, broker penalties, and records that protect you.
- Multi-loadingMulti-loading puts two or more NEMT riders with separately booked trips in one vehicle at once. Ride-time limits, billing rules, and when it makes sense.
- No-showA NEMT no-show is a rider who is not at the pickup after the driver waits the required time. Broker wait rules, reporting steps, and what it costs you.
- Pickup windowA pickup window is the span around a scheduled NEMT pickup when arrival counts as on time. Broker and state rules, the ADA paratransit standard, and an example.
- Revenue per vehicle hourRevenue per vehicle hour divides what a van earns by the hours it ran. The formula, why it beats revenue per trip, a worked example, and a target from costs.
- Same-day tripA same-day NEMT trip is a ride requested for today, outside the usual advance-booking rule. Notice rules by state, urgent pickup limits, and planning tips.
- Service areaA NEMT service area is the counties or ZIP codes a provider agrees to serve. How brokers use it to offer trips, the duties it carries, and out-of-area rules.
- Standing orderA standing order is a recurring NEMT ride booked once for a rider on a fixed schedule, like dialysis. How brokers handle them and what to watch for.
- Trip legA trip leg is one one-way NEMT ride from pickup to drop-off. How A and B legs work, why each leg carries its own status and miles, and how legs are billed.
- Trip logA NEMT trip log is the signed record of each ride as it happened. The fields Minnesota, Arizona, and Louisiana require, and the gaps that get claims denied.
- Trip manifestA NEMT trip manifest is the list of trips one driver runs in a day, in pickup order. What it contains, how it changes, and how it differs from a trip log.
- Trip turnbackA trip turnback is when a NEMT provider returns an accepted trip to the broker. Timing rules, accepted reasons, and what late turnbacks cost.
- Trips per hourTrips per hour is a NEMT productivity measure: completed one-way trips divided by hours in service. How to calculate it, a worked example, and what moves it.
- Vehicle utilizationVehicle utilization measures how much of a NEMT vehicle's time and miles produce paid work. Three ways to measure it, a worked example, and common fixes.
- Wait timeWait time in NEMT covers three rules: how long drivers wait at pickup, how long riders wait for a return, and when waiting is billable with T2007.
- Will-call tripA will-call trip is a NEMT return ride with no set pickup time. The rider calls when the appointment ends. How will-calls work and how to plan for them.
Service levels and vehicles
19 terms
- Ambulatory transportationAmbulatory transportation is NEMT for riders who can walk and sit in a regular seat. Who qualifies, vehicle and driver rules, and the codes used to bill it.
- AmbuletteAn ambulette is a wheelchair or stretcher van for nonemergency medical trips. How New York licenses and pays ambulettes, and how they differ from ambulances.
- Bariatric transportationBariatric transportation moves riders whose size or weight exceeds standard NEMT equipment. Lift and cot ratings, staffing, and how states bill these trips.
- Broda chairBroda chairs are tilt-in-space positioning wheelchairs. Which models are crash-tested as vehicle seats, how to secure them, and when to book a stretcher.
- Curb-to-curbCurb-to-curb is the most basic NEMT assistance level. What the driver does and does not do, how it compares with door-to-door and hand-to-hand, and who it fits.
- Door-through-doorIn door-through-door NEMT service, the driver helps the rider from inside the pickup building to inside the destination. Who offers it and who needs it.
- Door-to-doorIn door-to-door NEMT service, the driver helps the rider between the vehicle and the building door at each end. How programs define it and who needs it.
- GVWRGVWR is the most a vehicle may weigh fully loaded, as rated by its maker. What it means for wheelchair and stretcher vans: payload, lifts, CDL lines, and taxes.
- Hand-to-handIn hand-to-hand NEMT service, the driver takes the rider from one responsible person and hands them to another. Who needs it and how to run the handoff.
- Level of serviceLevel of service is the vehicle type and driver help a NEMT rider needs. How payers assign ambulatory, wheelchair, and stretcher levels and how each is billed.
- Livery vehicleA livery vehicle is a for-hire car used for ambulatory Medicaid rides. How livery works in New York City: TLC licenses, practitioner orders, and claim rules.
- Lowered-floor vanA lowered-floor van has a deeper floor so a seated wheelchair rider clears the door and roof. Side vs rear entry, headroom, ground clearance, and NEMT fit.
- ParatransitADA paratransit is the ride service transit agencies run for people who cannot use their buses or trains. How it differs from Medicaid NEMT in rules and fares.
- Stair chairA stair chair moves a seated rider up or down stairs when there is no elevator or ramp. How NEMT crews use one, weight limits, state rules, and billing.
- Stretcher transportationStretcher transportation moves a stable rider lying flat in a stretcher van with two crew. Who qualifies, equipment and staffing rules, and how T2005 is billed.
- Transport chairA transport chair is a light wheelchair with small wheels that a companion pushes. Why most are not built as vehicle seats, and how to handle riders in one.
- Wheelchair transportationWheelchair transportation carries riders seated in their own wheelchair in a lift or ramp van. Who qualifies, securement rules, and how A0130 trips are billed.
- Wheelchair-accessible vehicleA wheelchair-accessible vehicle has a lift or ramp, securement stations, and door clearance for riders who stay seated. ADA and FMVSS specs for NEMT vans.
- WTORSA WTORS is the set of tiedowns that anchor a wheelchair and the belts that restrain its rider. What each part does, the WC18 and J2249 tests, and daily checks.
Compliance and safety
10 terms
- Certificate of insurance (COI)A certificate of insurance is the one-page ACORD 25 summary of your policies. What NEMT brokers and customers require on it, and how to keep it current.
- Corrective action plan (CAP)Brokers and states demand a corrective action plan after an audit finding or a missed standard. What a NEMT provider puts in one, deadlines, and follow-up.
- Escort and attendantAn NEMT escort is a companion who rides with the patient. An attendant rides along to help. Who provides each, rules for minors, and how T2001 is billed.
- False Claims ActKnowingly false Medicaid bills cost triple damages plus a penalty per claim under the False Claims Act. How it reaches NEMT trips, brokers, and whistleblowers.
- Hired and non-owned auto (HNOA)Hired and non-owned auto coverage protects a business when rented or employee-owned cars are used for work. What it covers, its gaps, and when NEMT needs it.
- Medicaid Fraud Control Unit (MFCU)Medicaid Fraud Control Units are state prosecutors of provider fraud and patient abuse. How they work, the NEMT cases they bring, and what to do if one calls.
- Motor vehicle record (MVR)An MVR is the state record of a driver's license status, violations, and crashes. What NEMT brokers allow, how often to pull one, and consent rules.
- OIG exclusion list (LEIE)The LEIE is the federal register of people and firms banned from Medicaid and Medicare work. Who a NEMT company screens, how often, and what a miss costs.
- Portable oxygenRiders can bring portable oxygen on NEMT trips if they manage it themselves. Federal and state rules, securing tanks, which vehicle to send, and billing.
- Provider risk levelsEvery Medicaid provider is screened as limited, moderate, or high risk under 42 CFR 455.450. What each tier triggers and where transportation companies land.
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