NEMT rate sheet template for private pay and facility contracts
A NEMT rate sheet lists what you charge private-pay riders and facilities: a base rate per one-way trip for each level of service, a per-mile rate for loaded miles, and fees for wait time, extra stops, stairs, after-hours trips, late cancellations, and no-shows. Medicaid and broker trips are paid at the program's own rates, so the rate sheet covers everything else.
On this page
How to use this template
The owner fills in the brackets after working out what each trip actually costs to run. Price from your costs, not from a competitor’s number. The trip price calculator and our guide on how to price NEMT trips walk through the math, including deadhead miles and wait time.
- Who gets it. Private-pay riders and families, case managers, assisted living and memory care communities, hospitals, and any facility you bill directly.
- Where it goes. Attach it to every facility agreement, send it with quotes, and keep a copy at the dispatch desk so whoever answers the phone quotes the same price.
- Version control. Put an effective date on it and keep every old version. An invoice should always match the rates in effect on the trip date.
- Medicaid and broker trips are not priced from this sheet. They pay the program’s or broker’s contracted rate.
The template
Company details
| Field | Entry | Field | Entry |
|---|---|---|---|
| Company name | [Company name] | Phone | [phone] |
| Address | [address] | [email] | |
| Service area | [counties or ZIP codes] | Service hours | [days and hours] |
| Effective date | [date] | Rates valid until | [date] |
Base rates (per one-way trip)
| Level of service | Base rate | Loaded miles included | Each additional loaded mile |
|---|---|---|---|
| Ambulatory, curb-to-curb | [amount] | [number] | [amount] |
| Ambulatory, door-to-door | [amount] | [number] | [amount] |
| Wheelchair, rider’s own chair | [amount] | [number] | [amount] |
| Wheelchair, company-provided chair | [amount] | [number] | [amount] |
| Stretcher, two-person crew | [amount] | [number] | [amount] |
| [Other service] | [amount] | [number] | [amount] |
A round trip is billed as two one-way trips.
Add-on charges
| Item | Rate | How it is counted |
|---|---|---|
| Wait time | [amount] per [number] minutes | After [number] free minutes at pickup or at the appointment |
| Extra stop | [amount] | Per stop added to the trip |
| Additional passenger or escort | [amount] | Per person, per trip |
| Stair assistance or stair chair | [amount] | Per trip, or per flight of stairs |
| Oversized wheelchair or extra crew member | [amount] | Per trip |
| Portable oxygen on board | [amount] | Per trip, with a rider-supplied tank secured in the vehicle |
| After-hours service | [amount] or [percentage] | Pickups before [time] or after [time] |
| Weekend or holiday service | [amount] or [percentage] | Holidays listed: [holidays] |
| Same-day booking | [amount] | Booked less than [number] hours before pickup |
| Out-of-area miles | [amount] per mile | Miles driven outside the service area |
| Tolls and parking | At cost | Receipts available on request |
| Late cancellation | [amount] | Canceled less than [number] hours before pickup |
| No-show | [amount] | As defined in our no-show policy |
How miles are measured
Loaded miles run from the pickup address to the drop-off address, measured by [the shortest driving route in a named mapping tool, or GPS-recorded miles]. Miles are rounded [up to the next whole mile, or to the nearest tenth].
Payment terms
| Term | Entry |
|---|---|
| Payment methods accepted | [card, check, ACH, cash] |
| When payment is due | [at booking, at pickup, or net 30 from the invoice date] |
| Deposit | [amount, or none] |
| Invoices sent | [per trip, weekly, or monthly] |
| Late payment | [terms, if your state allows them] |
| Facility accounts | [terms set in the facility agreement] |
Optional: matching Medicaid codes
Some facilities and case managers ask how your services line up with Medicaid billing codes. Codes differ by state, so use your own state’s billing manual. Colorado’s is an example:
| Service | Colorado trip code | Colorado mileage code |
|---|---|---|
| Ambulatory or mobility vehicle | A0120 | S0215 |
| Wheelchair van | A0130 | S0209 |
| Stretcher van | T2005 | T2049 |
| Escort | T2001 | Not applicable |
Acceptance
| Field | Entry | Field | Entry |
|---|---|---|---|
| Customer or facility | Contact name and title | ||
| Signature | Date |
What brokers and auditors look for
A rate sheet is for accounts you bill directly, but it has to stay clear of Medicaid rules. Three points come up in audits and billing reviews.
- Broker trips pay the contract rate. CareOregon’s brokers approve a negotiated rate only if it was authorized before the trip, and can adjust payment when a provider bills more than the contracted rate. Providers may bill only the most cost-effective, reasonably direct route.
- Medicaid members cannot be billed extra. North Carolina Medicaid, restating CMS policy, says providers may not bill Medicaid beneficiaries for covered services beyond allowed copays, or for missed appointments. Your wait-time, no-show, and cancellation fees never apply to Medicaid members.
- Some charges are outside the Medicaid benefit. Colorado’s NEMT benefit excludes waiting time, cancellations, and charges for additional passengers, other than an escort for a child or an at-risk adult. Colorado pays mileage for the shortest trip length found by an internet-based map, trip planner, or GPS. It suspends ambulatory, taxi, and wheelchair van mileage claims above 52 miles, or 125 miles in designated rural counties, for review.
Direct routes matter in other states too. Minnesota requires trip records to show the mileage for the most direct route and the method used to find it. If your private-pay miles use the same method, one trip record supports every invoice. For the full code list, see our guide to NEMT billing codes.
Common mistakes
- Pricing without costs. A rate copied from another company ignores your insurance, deadhead miles, and wait time. Price from your own numbers.
- No mileage method. “Per mile” without saying how miles are measured invites disputes on every invoice.
- Free waiting. Without a written wait-time rule, a two-hour appointment becomes two unpaid hours for a driver and a vehicle.
- No effective date. Old rates end up on new invoices, or new rates get applied to old trips.
- Surprise fees. Charge only what the rate sheet lists, and share it before the first trip.
- Charging Medicaid members. Keep broker and Medicaid trips off this rate sheet entirely.
Cancellation and no-show fees need matching rules. Use the no-show policy template so both documents say the same thing.
Billing from the rate sheet
HealthRide turns completed trips into invoices, sends payment links, keeps cards on file, and records check, ACH, wire, and cash payments in one ledger. Facilities can view and pay their invoices online. See invoicing and payments.
Frequently asked questions
- What should a NEMT rate sheet include?
- A base rate per one-way trip for each level of service, the loaded miles included in that base rate, a rate per additional mile, and every add-on you charge, such as wait time, extra stops, stair assistance, after-hours service, late cancellations, and no-shows. Add your service area, payment terms, and an effective date so nobody argues over which rates applied.
- How should I measure miles on a rate sheet?
- State the method in writing and use it every time. Charge loaded miles from pickup to drop-off. Colorado Medicaid pays mileage for the shortest trip length found with an internet-based map, trip planner, or GPS, and Minnesota requires trip records to show the most direct route and how it was found. Using the same method for private pay keeps invoices easy to defend.
- Should I charge for deadhead miles?
- Build them into your rates instead of billing them as a line item. Medicaid programs set their own rules on empty miles. Colorado, for example, excludes charges incurred while the member is not in the vehicle. For private pay, cover normal deadhead in the base rate and use an out-of-area mileage charge for trips that start or end outside your service area, as this template does.
- Can I charge the IRS standard mileage rate per mile?
- No. The IRS business mileage rate is 76 cents a mile for July 1 to December 31, 2026, and was 72.5 cents for the first half of the year. It is a tax deduction figure for driving a car on business. It does not cover a driver's wages, commercial insurance, accessible equipment, or empty miles. Price from your own cost per mile.
- Can I charge Medicaid riders for extras like wait time?
- Not on Medicaid trips. North Carolina Medicaid, restating CMS policy, says providers may not bill Medicaid beneficiaries for covered services beyond allowed copays, or for missed appointments. Some programs also exclude items from the benefit entirely. Colorado's NEMT benefit does not cover waiting time, cancellations, or charges for additional passengers unless they are escorting a child or an at-risk adult.
- Do broker trips use my rate sheet?
- No. Broker trips are paid at the rate in your broker contract. CareOregon's brokers approve negotiated rates only when authorized before the trip, and can adjust payments when a provider bills above the contracted rate. Your rate sheet is for private-pay riders, facilities, and other accounts you bill directly.
- How often should I update my rate sheet?
- Review it at least once a year and whenever a major cost changes, such as insurance, fuel, or wages. Put an effective date on every version and keep the old ones. An invoice should always match the rate sheet that was in effect on the date of the trip.
