What are deadhead miles in NEMT?
Overview
Deadhead miles are the miles a NEMT vehicle drives with no rider on board: from the garage to the first pickup, between a drop-off and the next pickup, and back to base at the end of the day. Medicaid pays fee-for-service NEMT providers only for loaded miles, so every deadhead mile is a cost the provider absorbs.
On this page
What counts as a deadhead mile
In NEMT, a deadhead mile is any mile driven without a rider in the vehicle. Three stretches of the day produce most of them:
- Pull-out. The drive from the garage, or the driver’s home, to the first pickup.
- Between trips. The drive from one drop-off to the next pickup, including repositioning near a clinic for a will-call return.
- Pull-in. The drive from the last drop-off back to base.
Transit agencies use the word a little more narrowly. The FTA’s National Transit Database defines deadhead as the miles and hours a vehicle travels out of revenue service, such as leaving or returning to the garage. Under that definition, a transit van driving between two scheduled riders generally counts as revenue service. NEMT billing does not work that way. It pays for miles with the rider in the seat, so NEMT operators treat every empty mile as deadhead.
Why deadhead is pure cost
Medicaid pays for loaded miles, not driven miles. CMS’s provider booklet says states and contracted transportation entities may only pay fee-for-service transportation providers for loaded mileage. Arizona’s AHCCCS manual, revised July 31, 2026, says a NEMT provider may not submit any claim for unloaded mileage. Colorado’s NEMT billing manual excludes charges incurred while the member is not in the vehicle. Fuel, wear, and driver wages on empty miles all come out of your margin.
What deadhead costs
Empty miles cost the same as loaded ones in fuel, wear and driver time. To see what yours add up to, run your own numbers in the deadhead cost calculator, and read how to reduce NEMT deadhead miles for how to measure your share and bring it down. High deadhead also drags down vehicle utilization and trips per hour.
Where software helps
Chaining dozens of trips by hand is where empty miles creep in. Ryder Go, HealthRide’s route optimizer, plans your whole day in one click and starts each route from where every driver actually is.
Frequently asked questions
- Is a deadhead mile the same as an unloaded mile?
- In NEMT, yes. CMS calls the same miles unloaded miles or no load miles, and every mile driven without a rider aboard counts. Transit agencies use deadhead more narrowly, for miles a vehicle travels out of revenue service, such as leaving or returning to the garage.
- What is the opposite of a deadhead mile?
- A loaded mile, driven from pickup to drop-off with the rider aboard. Loaded miles are the ones fee-for-service mileage rates normally pay for.
- Why does it matter whether a mile is deadhead?
- Because fee-for-service Medicaid pays for loaded miles only, an empty mile is a cost with no payment against it. CMS lets states fold that cost into the rates they pay, so in some programs the base rate is where deadhead gets paid for, and in others it comes out of your margin.
