What is level of service in NEMT?
Level of service is the kind of transportation a NEMT rider needs on a trip. It has two parts: the vehicle type (ambulatory, wheelchair van, or stretcher van) and how much hands-on help the driver gives, from curb-to-curb up to hand-to-hand. The broker or state assigns it at booking from the rider's medical needs, and it sets the billing code and rate.
On this page
What level of service covers
Level of service describes what a rider needs to get to care safely. It combines two separate choices:
- Mode. The vehicle and equipment: a sedan or minivan, a wheelchair van with a lift or ramp, or a stretcher van.
- Assistance level. How far the driver goes to help: from the curb, from the door, from inside the building, or from one caregiver’s hands to another’s.
Federal Medicaid rules leave the details to the states. 42 CFR 440.170 lists wheelchair vans, taxis, stretcher cars, bus passes, and secured transportation among the services a state NEMT broker program can provide. Each state then defines its own modes, and brokers write them into provider contracts.
The main modes
State programs such as Virginia’s, California’s, Colorado’s, and Minnesota’s use the same core ladder, with local names and codes. The codes below are the HCPCS base and mileage pairs Colorado’s billing manual uses.
| Mode | Who it fits | Typical vehicle | Base code | Mileage code |
|---|---|---|---|---|
| Ambulatory | Walks and gets in and out with little help | Sedan, minivan, taxi | A0100 or A0120 | S0215 |
| Wheelchair | Rides seated in their own wheelchair | Van with lift or ramp and securement | A0130 | S0209 |
| Stretcher | Must lie flat, is stable, needs no monitoring | Stretcher van with two crew | T2005 | T2049 |
| Ambulance | Needs medical care or monitoring en route | BLS or ALS ambulance | Ambulance codes | Ambulance mileage |
Below the ambulatory level, many programs pay for bus passes or mileage reimbursement instead of a ride. Above the stretcher van sits the ambulance. Some programs still count a non-emergency ambulance ride as NEMT. Medi-Cal names ambulance, litter van, and wheelchair van as its three NEMT vehicle types, and Virginia lists non-emergency ambulance as its highest level. Those trips bill under ambulance codes. Detail on each mode lives on its own page: ambulatory, wheelchair, and stretcher.
Assistance levels
Assistance levels have less standard wording than modes. NEMTAC’s Levels of Service Standard (version 1.0, approved by NEMTAC’s board for ANSI review on October 11, 2024) defines six:
- Curb-to-curb
- Curb-to-curb with assistance
- Door-to-door
- Door-through-door
- Hand-to-hand
- Transfer services (moving the rider to or from a stretcher or mobility device)
NEMTAC wrote the standard so providers, brokers, payers, and regulators use the same terms. It is still pending review as an American National Standard, and your state or broker contract may define the levels differently. States often use fewer levels. Virginia’s Medicaid handbook lists three: curb-to-curb, door-to-door, and hand-to-hand. The last two require medical necessity.
How the level gets set and paid
The payer sets the level, and payment follows it:
- Assessment at booking. Minnesota requires its NEMT administrator to use the state’s level-of-service process to pick each client’s mode.
- Medical documentation. Colorado requires a written statement from the member’s medical professional for wheelchair van and stretcher van trips.
- Lowest adequate cost. California’s 22 CCR 51323 approves only the lowest cost type of transportation that meets the patient’s medical needs and is available.
- Paid by assessed level. Minnesota pays by the client’s assessed mode, not the vehicle used.
- Upgrades. When the right mode is not available, Minnesota allows a one-time service upgrade.
Check the level on every trip before you accept it. Where payment follows the assessed level, as in Minnesota and Colorado, a trip booked as ambulatory pays the ambulatory rate even if a wheelchair van ran it. The NEMT billing codes guide covers the full code set.
Matching levels to vehicles
Dispatch has to put each level on a vehicle that can carry it. In HealthRide, wheelchair, stretcher, oxygen, and stair-chair requirements are checked on every assignment, using the capabilities saved on each vehicle in Fleet.
Frequently asked questions
- Who decides a rider's level of service?
- The payer does, not the transportation provider. Brokers and state Medicaid programs assign it during booking, often from a medical professional's statement. Colorado, for example, covers wheelchair van and stretcher van trips only when the member's medical professional states in writing that less costly modes will not work.
- What happens if I send a bigger vehicle than the trip needs?
- Often you are paid for the level that was assessed, not the vehicle you sent. Minnesota law says NEMT payments follow the client's assessed mode, not the type of vehicle used. Colorado makes a wheelchair van bill ambulatory codes when the member has no written statement that they are wheelchair-confined. In both states, a wheelchair van that runs an ambulatory trip earns the ambulatory rate.
- Is level of service the same as the assistance level?
- No. The mode is the vehicle, and the assistance level is how far the driver helps the rider: to the curb, to the door, inside the building, or into the hands of a caregiver. Every trip has both. A wheelchair van trip can be curb-to-curb or door-to-door.
