# What Is a Medicaid Fee Schedule? How to Read Yours and Find Your State's NEMT Rates

Canonical URL: https://nemtguide.com/glossary/fee-schedule/ · Updated 2026-09-28

A Medicaid fee schedule is your state's list of the most Medicaid pays for each billing code on a given date, such as a wheelchair van base rate or a loaded mile. Many states post a new version each year on a set date, and federal rules required every state to post its fee-for-service rates online by July 1, 2026. Broker and health plan trips pay your contract rate.

- A fee schedule is usually a ceiling. Ohio and South Dakota pay the lower of your usual charge or the listed maximum.
- The rate in effect on the date of service is the one that applies, so an update date splits trips on either side of it.
- Read the modifiers, units, effective dates, and notes, not just the dollar column. They change what a trip pays.
- A new schedule does not always mean new rates. Nebraska's July 1, 2026 schedule carried no increase.
- Fee schedules set fee-for-service pay. Broker and health plan trips pay the rate in your agreement.

Before you take a Medicaid trip, you want to know what it pays. For trips your state pays directly, the answer is on its fee schedule. For broker and health plan trips, the fee schedule is often the starting point for the rate in your contract.

## What a Medicaid fee schedule is

A fee schedule lists each billing code the state pays and the most it pays for one unit of that code on fee-for-service claims. For NEMT, a unit is usually one one-way trip, one loaded mile, one half hour of waiting, or one attendant. States name the amount differently: the "Medicaid allowable" in Nebraska, the "maximum allowable amount" in South Dakota, the "Medicaid maximum payment amount" in Ohio.

Four rules apply to most schedules:

- **It is usually a ceiling.** Ohio pays the lower of your submitted charge or the Medicaid maximum (rule 5160-15-28, effective August 1, 2026). South Dakota tells providers to bill their usual and customary charge, and its fee is the most it pays. Bill your normal price and let the program pay the lower amount.
- **The date of service picks the rate.** Ohio pays against the maximum "for the date of transport." When a new schedule starts, trips before that date still pay the old rate.
- **It is payment in full.** Under [42 CFR 447.15](https://www.ecfr.gov/current/title-42/section-447.15), a Medicaid provider accepts the state's payment as payment in full, so you cannot bill the rider the difference.
- **A listed code is not a promise of coverage.** North Dakota's schedule says including or leaving out a code does not mean Medicaid covers it or not. Coverage rules, such as prior authorization and distance limits, are in the billing manual.

Most NEMT rates have two parts, a base rate per trip and a mileage rate per loaded mile. For every state's numbers side by side, see [NEMT reimbursement rates](https://nemtguide.com/guides/nemt-reimbursement-rates/).

## How to read a NEMT fee schedule

Most schedules share the same core columns, even when the labels differ. These examples come from schedules in effect in 2026.

| Column | What it tells you | Example |
|---|---|---|
| Procedure code | The HCPCS code you bill | A0130, wheelchair van base rate |
| Modifier | A version of the code with its own rate | Arizona's TN modifier for trips starting outside the Phoenix and Tucson metro areas: A0130 pays $11.15 urban and $12.21 rural, the same in the schedules effective October 1, 2025 and October 1, 2026 |
| Rate, fee, or allowable | The most paid per unit | Nebraska's A0130 allowable is $46.12 (July 1, 2026) |
| Unit | What one unit is | South Dakota's S0209 is per whole loaded mile, at $2.61 (July 1, 2026) |
| Effective date | When that rate started | Louisiana's schedule effective October 1, 2025 still shows T2003 at $13.50, in effect since January 1, 2022 |
| Authorization | Whether the service needs approval first | North Dakota's "Service Authorization Required" column and Nebraska's "PA" column |
| Notes | Limits that change what pays | South Dakota pays secure van mileage only outside city limits |

Three more things to look for:

- **Rates by place.** Illinois sets rates by county. On its schedule effective January 1, 2026, wheelchair van mileage is $1.03 a mile in Cook, DuPage, Kane, Lake, McHenry, and Will counties, $1.61 in Madison and St. Clair, and $0.80 elsewhere. Texas pays its demand response trip code, T2003, at three rates set by the modifiers U1, U2, and U3: $33.83, $79.63, and $62.31 as of September 1, 2026.
- **Rates by provider type.** Arizona's schedule has a second rate column for rideshare companies, which applies only to the AHCCCS health plans' capped fee schedule.
- **Rounding.** Nebraska's payment system uses seven decimal places while its schedule shows two, so payments can differ slightly from the schedule.

## How often NEMT fee schedules change

Many states update on a set date each year. As of September 2026:

- **Arizona:** October 1 each year. Its next schedule takes effect October 1, 2026.
- **Texas:** Demand response rates took effect September 1, 2026. The Texas fee schedule says Medicaid rates are reviewed every two years or as needed.
- **Nebraska, North Dakota, and South Dakota:** July 1, 2026.
- **Illinois:** January 1, 2026.

A new file does not always mean new rates. Nebraska's July 1, 2026 schedule says rates did not rise because no increase was funded for the state fiscal year. Ohio's wheelchair van rates, $31.00 a trip plus $1.30 a mile, date from January 1, 2024, even though rule 5160-15-28 was updated August 1, 2026. Always check the effective date on each line, not only the date on the file.

Two federal rules help you see changes coming:

- **Notice before a change.** [42 CFR 447.205](https://www.ecfr.gov/current/title-42/section-447.205) requires public notice of any significant proposed change in how a state sets rates. The notice must come out before the change takes effect, in a state register, a major newspaper, or the agency's website, with an address for written comments.
- **Posting after a change.** Under [42 CFR 447.203](https://www.ecfr.gov/current/title-42/section-447.203), each state posts all its fee-for-service rates on a public website linked from its Medicaid agency's site. The page must show when rates were last updated and be updated within one month of a change.

Sign up for your state's provider bulletins so you see proposed changes early. South Dakota's schedule points providers who want a rate or coverage change to its Reconsideration, Reviews, Coverage Requests, and Fair Hearing manual. For how rates actually get raised, see NEMT rate increases.

## Where states post their NEMT fee schedules

Select a state to open its latest schedule.

| State | Schedule | Effective |
|---|---|---|
| [Arizona](https://www.azahcccs.gov/PlansProviders/Downloads/FFSrates/Transportation/FY27_FinalWebsiteRates_TransGroundNEMT.xlsx) | Final Ground Non-Emergency Medical Transportation Rates | October 1, 2026 |
| [Illinois](https://hfs.illinois.gov/content/dam/soi/en/web/hfs/medicalproviders/medicaidreimbursement/transportation/nonambulancefs01012026.xlsx) | Non-Ambulance Transportation Fee Schedule | January 1, 2026 |
| [Louisiana](https://www.lamedicaid.com/provweb1/fee_schedules/NEMT_Rates.xlsx) | NEMT Fee Schedule | October 1, 2025 |
| [Nebraska](https://dhhs.ne.gov/Medicaid%20Practitioner%20Fee%20Schedules/REVISED%20471-000-503%20NET%20-%20July%20%2726.xlsx) | 471-000-503 Fee Schedule for NET Services | July 1, 2026 |
| [North Dakota](https://www.hhs.nd.gov/sites/default/files/documents/rate-2026-july-nemt-fee-schedule.xlsx) | ND Medicaid NEMT Services Fee Schedule | July 1, 2026 |
| [Ohio](https://codes.ohio.gov/assets/laws/administrative-code/pdfs/5160/0/15/5160-15-28_PH_FF_A_APP2_20260710_1407.pdf) | Appendix to rule 5160-15-28 | Wheelchair van rates since January 1, 2024 |
| [South Dakota](https://dss.sd.gov/docs/medicaid/providers/feeschedules/Other_Services/Transportation_Services_Current.pdf) | Transportation Services Fee Schedule | July 1, 2026 |
| [Texas](https://public.tmhp.com/FeeSchedules/StaticFeeSchedule/FeeSchedules.aspx?fn=%5C%5Ctmhp.net%5CFeeSchedule%5CPROD%5CStatic%5CTexas_Medicaid_Fee_Schedule_PRCR706C.pdf) | Medical Transportation, Demand Response Transportation Services Provider | September 1, 2026 |

For any other state, find the Medicaid agency on [Medicaid.gov's state overviews](https://www.medicaid.gov/state-overviews), then follow the fee schedule link that 447.203 requires on its site. Look under transportation, NEMT, or ambulance. Our [state guides](https://nemtguide.com/states/) cover how each state runs its rides.

## Fee schedule rates and broker or health plan rates

A fee schedule sets what the state pays on fee-for-service claims. Many riders get their trips through a broker or health plan instead, and those trips pay the rate in your agreement. Ohio's rule says it plainly: for a health plan member, the provider agreement sets the payment.

Some states tie contract rates to the schedule. Louisiana's Medicaid manual (Chapter 10, issued July 14, 2025) says brokers must pay at least the published fee-for-service rate in effect on the date of service, unless the broker and provider agree otherwise in the provider agreement. Ask every broker and plan for the rate exhibit in your agreement and compare it with your state's schedule. See [how to bill NEMT brokers](https://nemtguide.com/guides/how-to-bill-nemt-brokers/) and [fee-for-service Medicaid](https://nemtguide.com/glossary/fee-for-service-medicaid/).

## How to use your fee schedule

1. **Save the current file with its effective date.** You will need it to check old payments after the next update.
2. **Find your codes.** List the base, mileage, wait time, attendant, and extra rider codes for each level of service you run. The full code list is in [NEMT billing codes](https://nemtguide.com/guides/nemt-billing-codes/).
3. **Read the modifiers and notes.** Rural, county, and extra rider rules change what a trip pays.
4. **Price a typical trip.** Trip pay = base rate + (paid miles × mileage rate). Compare it with your own cost per trip before you accept work.
5. **Bill your usual charge.** Where the state pays the lower of your charge or the maximum, billing less than the maximum leaves money unpaid.
6. **Check again on the update date.** Put your state's update date on your calendar and reprice your trips when it changes.

## Frequently asked questions

### Where do I find my state's Medicaid fee schedule for transportation?

On your state Medicaid agency's website. Under 42 CFR 447.203, every state had to post its fee-for-service rates on a public website by July 1, 2026, linked from the agency's site and showing when rates were last updated. Look for a transportation, NEMT, or ambulance schedule. Medicaid.gov's state overviews list every state's agency if you do not know where to start.

### Is the fee schedule amount what I will be paid?

It is the most you can be paid for that code, not a promise. Ohio pays the lower of your submitted charge or the Medicaid maximum for the date of transport, and South Dakota tells providers to bill their usual and customary charge. Coverage rules, such as mileage paid only outside city limits, can cut the amount further. You cannot bill the rider for the difference.

### How often do Medicaid fee schedules change?

Many states update on a set date. As of September 2026, Arizona updates each October 1 and its next schedule takes effect October 1, 2026. Texas rates took effect September 1, 2026, Nebraska, North Dakota, and South Dakota July 1, 2026, and Illinois January 1, 2026. The Texas fee schedule says rates are reviewed every two years or as needed. A new file can still repeat old rates, as Nebraska's did in 2026.

### Do brokers have to pay the Medicaid fee schedule rate?

Only where the state requires it. Louisiana's Medicaid manual says brokers must pay at least the published fee-for-service rate in effect on the date of service, unless the broker and provider agree otherwise in the provider agreement. Ohio says pay for a health plan member is set by your provider agreement. Ask each broker for the rate exhibit in your contract.

### Which rate applies when the fee schedule changes mid-month?

The one in effect on the date of service. Ohio pays against the Medicaid maximum for the date of transport, and Louisiana ties broker payments to the rate in effect on the date of service. A trip on September 30 is paid at the old rate and a trip on October 1 at the new one, even if you bill both on the same day.

## Official resources

- [Medicaid.gov: State overviews (find your state Medicaid agency)](https://www.medicaid.gov/state-overviews)
- [AHCCCS: Ground transportation fee schedules](https://www.azahcccs.gov/PlansProviders/RatesAndBilling/FFS/transportationground.html)
- [Nebraska DHHS: Medicaid provider rates and fee schedules](https://dhhs.ne.gov/Pages/Medicaid-Provider-Rates-and-Fee-Schedules.aspx)
- [North Dakota HHS: Medicaid fee schedules](https://www.hhs.nd.gov/healthcare/medicaid/provider/fee-schedules)
- [South Dakota Medicaid: Fee schedules](https://dss.sd.gov/medicaid/providers/feeschedules/)
- [Louisiana Medicaid: NEMT fee schedules](https://www.lamedicaid.com/provweb1/fee_schedules/NEMT_Fee.htm)
- [TMHP: Texas Medicaid fee schedules](https://public.tmhp.com/FeeSchedules)
- [eCFR: 42 CFR 447.203, state rate publication rule](https://www.ecfr.gov/current/title-42/section-447.203)