Does Medicare Cover Non-Emergency Transportation? What NEMT Owners Can Bill in 2027

Many of your riders have Medicare. That does not mean Medicare pays for their rides. Original Medicare has one ride benefit, the ambulance, and it pays nothing for the sedans, wheelchair vans, and stretcher vans most NEMT companies run. The money for those rides comes from other programs, and the rider’s cards tell you which one.

Does Original Medicare cover non-emergency transportation?

Not in a car, van, wheelchair van, or stretcher van. Medicare Part B covers “ambulance service where the use of other methods of transportation is contraindicated by the individual’s condition” (42 U.S.C. 1395x(s)(7)). CMS’s Medicare Benefit Policy Manual (chapter 10, revised November 26, 2025) spells out the test. If any other vehicle could carry the patient without endangering their health, Medicare pays nothing for the ambulance, whether or not that other vehicle is actually available.

CMS’s code file says the same. In the October 2026 HCPCS file, every non-emergency transportation code carries coverage code I, “not payable by Medicare.” Ambulance codes carry code C, which means the Medicare contractor decides each claim.

Ride	Does Original Medicare pay?	Codes (October 2026 HCPCS file)
Sedan, taxi, or rideshare	No	A0100, T2003
Wheelchair van	No	A0130, S0209
Stretcher van	No	T2005, T2049
Mileage paid to a volunteer, the member, or family	No	A0080, A0090
Attendant, wait time, tolls, meals, lodging	No	T2001, T2007, A0170 to A0210
Non-emergency ambulance	Yes, when the patient’s condition requires it	A0428 (basic), A0426 (advanced), A0425 (mileage)

A doctor’s office is not a covered destination, even by ambulance. The manual makes one exception: an ambulance headed to a covered place may stop at a doctor’s office when the patient urgently needs professional attention, then continue. The Medicare & You 2027 handbook (September 2026) lists rides to doctor visits among the extra benefits some Medicare Advantage plans may offer, not as a Medicare benefit. For how each code is billed elsewhere, see NEMT billing codes.

When Medicare pays for a non-emergency ambulance ride

Part B covers a non-emergency ambulance trip only when the patient’s condition makes other transport unsafe, and the condition must call for both the ambulance and the level of care billed (42 CFR 410.40). Being bed-confined is one sign, but not the only one. Medicare counts a patient as bed-confined only if all three are true:

• They cannot get up from bed without help.
• They cannot walk.
• They cannot sit in a chair or wheelchair.

A rider who can sit in a wheelchair is not bed-confined, so Medicare would need another medical reason for the ambulance. The trip must also go to a covered place:

• From anywhere to the nearest hospital, critical access hospital, rural emergency hospital, or skilled nursing facility that can treat the patient
• From one of those places to the patient’s home
• From a skilled nursing facility to the nearest supplier of a needed service the facility lacks, and back
• For a dialysis patient, from home to the nearest dialysis facility, and back

The paperwork Medicare requires

Trip	What the ambulance company needs
Scheduled and repeated, such as dialysis three times a week	A physician certification statement dated no more than 60 days before the trip, on file before the trip
Unscheduled, for a facility resident under a doctor’s care	A physician certification statement within 48 hours after the trip
Unscheduled, for someone not under a doctor’s direct care	No physician certification
Unscheduled, and the doctor’s statement cannot be obtained	A statement from a physician assistant, nurse practitioner, clinical nurse specialist, RN, LPN, social worker, case manager, or discharge planner who knows the patient’s condition and works for the doctor or the facility
Unscheduled, and no statement after 21 calendar days	Proof of the attempts, such as a signed mail return receipt, then file the claim

Repeated trips also face prior authorization. Under a CMS model that has covered every state since August 1, 2022, when a patient rides 3 or more round trips in 10 days, or at least once a week for 3 weeks, the ambulance company or the patient can request prior authorization before the fourth round trip in 30 days. The request is voluntary, but if the company skips it, Medicare reviews those claims before paying. Medicare.gov warns that if the request is not approved and the trips continue, Medicare denies the claims and the ambulance company may bill the patient. See prior authorization.

What Medicare pays for an ambulance trip in 2026

CMS’s 2026 ambulance fee schedule file starts from a ground base rate of $284.56, then adjusts it for local costs and for urban or rural pickup.

Code	Service	2026 Medicare amount
A0428	Non-emergency basic life support, urban pickup	$261.60 to $380.05, by locality
A0428	Non-emergency basic life support, rural pickup	$264.17 to $383.78, by locality
A0428	Non-emergency basic life support, pickup in the least populated rural areas	$323.87 to $470.51, by locality
A0425	Ground mileage, urban pickup	$9.33 per mile
A0425	Ground mileage, rural pickup	$14.13 per mile for miles 1 to 17, then $9.42

These amounts include temporary add-on payments that Congress extended through December 31, 2027, among them a 22.6 percent higher base rate in the least populated rural areas. CMS says its file is for information only: your Medicare contractor’s fee schedule is the official one and can differ slightly.

Since October 1, 2018, Medicare has paid 23 percent less, on both the base rate and mileage, for non-emergency basic life support trips to dialysis (42 CFR 414.610). The patient pays 20 percent of the approved amount after the Part B deductible, which is $283 in 2026. If an ambulance company expects Medicare to deny a non-emergency trip, Medicare.gov says it must give the patient an Advance Beneficiary Notice of Noncoverage (Form CMS-R-131).

Can a NEMT company bill Medicare?

Only as an ambulance supplier. Under 42 CFR 410.41, the vehicle must be designed to respond to medical emergencies or give acute medical care and must meet state and local rules for emergency vehicles. It needs the warning lights, siren, and radio or wireless phone that state or local law requires, plus a stretcher, oxygen, and emergency medical supplies. At least two crew members must staff it, and at least one must be certified as an EMT-Basic or higher. A wheelchair van or stretcher van without that equipment and crew does not meet those rules.

You do not need Medicare to run Medicaid or health plan rides. CMS’s January 14, 2025 billing FAQs on dual eligible patients say there is no federal requirement for Medicaid providers to enroll in Medicare. They add that Medicare Advantage plans generally do not require out-of-network providers to enroll in Medicare for extra benefits the plan covers.

Never send a van ride claim to Original Medicare. The same FAQs say providers not enrolled in Medicare should not submit claims to it, so you will never have a Medicare denial to attach. For where the line between the two services falls, see NEMT vs ambulance and how to start a stretcher transportation business.

Medicare Advantage: rides as an extra benefit

As of September 2026, about 36 million people were in Medicare Advantage plans, including about 8.5 million in special needs plans (CMS monthly contract summary). These plans must cover the Part A and Part B services Original Medicare covers, with a few exceptions such as hospice, and that includes ambulance trips. They may also add benefits Original Medicare does not cover, called supplemental benefits (42 CFR 422.100).

Rides are one of those extras. CMS’s Medicare Managed Care Manual (chapter 4, section 30.3, revised April 22, 2016) says a plan does not have to provide rides to non-emergency Part A and Part B services, but may offer them as a supplemental benefit. The rides must serve the member’s health care, such as trips to doctor visits, and the plan must arrange them or provide them itself. The Medicare & You 2027 handbook tells members these benefits are generally limited.

Two kinds of plan rides go beyond routine medical trips:

• Rides for chronically ill members. CMS guidance of April 24, 2019 lets plans offer members with qualifying chronic conditions rides for non-medical needs, such as grocery shopping or banking, as a special supplemental benefit.
• Transplant travel. A plan that sends a member to a distant transplant center must provide reasonable transportation for the member and a companion (Medicare Managed Care Manual, chapter 4, section 10.11).

Limits vary by plan. CarePlus, a Florida plan, said on October 22, 2025 that all of its 2026 plans include transportation, with unlimited rides on its dual eligible special needs plans, and that quantity limits and other restrictions may apply. Ask the plan or the member for the ride limits before you count on repeat trips.

How Medicare Advantage rides reach your vans

Some plans hand their rides to a broker, including brokers that also manage Medicaid trips. HealthSpring moved its Medicare Advantage members’ rides from Modivcare to MTM Health on March 1, 2026, making MTM its sole NEMT provider for those members. To get these trips, join the broker’s network, then ask its provider relations team which Medicare Advantage plans it serves in your area. See how to get NEMT broker contracts and Medicare Advantage transportation.

Ride benefits can change every January 1. Plans must tell members about changes at least 15 days before the annual election period, which runs October 15 to December 7 (42 CFR 422.111 and 422.62). For 2027 plans, that election period is October 15 to December 7, 2026, and the new benefits start January 1, 2027. Ask each broker this fall which plans it will manage in 2027.

Medicaid covers rides for many Medicare members

Every state Medicaid plan must ensure necessary transportation to and from providers (42 CFR 431.53). That duty reaches people with both Medicare and Medicaid, called dual eligible members. CMS’s Medicaid Transportation Coverage Guide (SMD 23-006, September 28, 2023) says Medicare pays first for services both programs cover, but its ride benefit is limited. So when a full-benefit dual eligible member gets a Medicaid-coverable service that Medicare pays for first, the state must still ensure the ride.

The same guide sets two limits:

• Rides to Medicare services that Medicaid does not cover are optional. For example, a state may choose to cover rides to the pharmacy for Part D drugs, which Medicaid excludes by law, if doing so is cost effective.
• Only full-benefit dual eligible members count. That means members in QMB Plus, SLMB Plus, and other full Medicaid groups.

Full or partial Medicaid: check before you book

Group	What Medicaid pays (CMS fact sheet, June 2024)	Medicaid rides?
QMB Plus, SLMB Plus, other full Medicaid	Full Medicaid benefits, plus some or all Medicare premiums and cost sharing	Yes, under your state’s NEMT rules
QMB only	Part A and Part B premiums, deductibles, coinsurance, and copays	Generally no. Medicaid pays only Medicare costs.
SLMB only	Part B premium	Generally no
Qualifying Individual (QI)	Part B premium, and no other Medicaid is allowed	No
Qualified Disabled Working Individual (QDWI)	Part A premium, and no other Medicaid is allowed	No

Dual eligible members use rides more than most Medicaid members. In 2019, 17 percent of full-benefit dual eligible Medicaid members, about 1.5 million people, used NEMT, and they averaged 2.3 ride days a month. Across all Medicaid members, 5 percent used NEMT that year, on fewer than two days a month (CMS Report to Congress, NEMT in Medicaid, 2018 to 2020).

Billing Medicaid for a dual eligible rider

• No Medicare denial to wait for. CMS’s January 14, 2025 FAQs say Medicare is not a liable third party for a service from a provider not enrolled in Medicare. A state can use an override code to pay those claims without a Medicare denial, and may ask you to keep yearly records showing Medicare does not cover the service. See third party liability.
• The plan may come first. If the rider’s Medicare Advantage plan covers rides and pays out-of-network providers, your state may require you to bill the plan before Medicaid.
• Medicaid’s payment is payment in full. Providers in the Medicaid program must accept Medicaid’s payment, plus any copay the state allows, as payment in full (42 CFR 447.15). Do not bill the rider the difference.

For claim steps, see how to bill Medicaid for NEMT. To check coverage before each trip, see eligibility verification.

PACE, facilities, and private pay

PACE. The Program of All-Inclusive Care for the Elderly serves people 55 or older who live in a PACE service area, are certified by their state as needing a nursing home level of care, and can live safely in the community with PACE’s help (Medicare & You 2027). PACE must cover all Medicare and Medicaid services (42 CFR 460.92), and the handbook names transportation among them. Members with Medicare but no Medicaid pay a monthly premium, so PACE can give rides to seniors who have no Medicaid. In September 2026, CMS counted 208 PACE contracts with 81,439 members. A PACE organization may use a contractor for rides. It must make sure the contractor’s vehicles are maintained to the manufacturer’s recommendations and can communicate with the PACE center, and it must train all transportation staff, including contractors, to manage participants’ special needs and handle emergencies (42 CFR 460.76). See PACE transportation contracts.

Hospitals and nursing facilities. When a hospital or skilled nursing facility sends an admitted patient to another site for care, and the patient stays admitted there, Medicare counts the trip as part of the facility’s own Part A service (Medicare Benefit Policy Manual, chapter 10, section 10.3.3). For a nursing facility, this applies during a covered Part A stay. The company that gives the ride bills the facility, not Medicare. A Medicare-only patient’s wheelchair van ride home has no Medicare benefit, so the patient, the family, or the facility pays. See hospital discharge transportation and NEMT facility contracts.

Private pay. A rider with only Original Medicare, or whose plan has no rides left, pays you directly or has family pay. Set the price before the trip. See private pay NEMT and how much to charge for NEMT.

Who pays for a Medicare rider’s trip

Rider	Who pays for a van ride	What you do
Original Medicare only	The rider, family, or a facility	Quote a private pay price before the trip
Medicare Advantage plan with a ride benefit	The plan, often through its broker	Join the broker’s network
Medicare Advantage plan, no Medicaid, and no ride benefit or rides used up	The rider, family, or a facility	Quote a private pay price
Medicare and full Medicaid	Medicaid, through the state, its broker, or a health plan	Take the trip through the Medicaid system
Medicare and partial Medicaid (QMB only, SLMB only, QI, QDWI)	The rider, family, or a facility, unless a plan covers rides	Check eligibility and any plan benefit
PACE member	The PACE organization	Contract with the PACE organization
Hospital or skilled nursing facility inpatient going out and back	The facility	Work under a facility agreement
Needs care during the ride	Medicare, Medicaid, or a plan, as an ambulance trip	Refer the trip to an ambulance company

How to check who pays before you accept a Medicare rider

1. Ask for every card. Get the Medicare card, any Medicare Advantage or PACE card, and any Medicaid card. Many riders have more than one.
2. Check Medicaid eligibility for the date of the trip. Use your state’s eligibility system or your broker. Note whether the rider has full Medicaid or only help with Medicare costs.
3. Call the plan if there is one. Use the member services number on the plan card. Ask whether the plan covers rides, how many are left this year, and which company books them.
4. Send ambulance trips to an ambulance company. If the rider needs medical care or monitoring on the way, the trip does not belong in a van. Medicare’s test is whether any other vehicle could endanger the rider’s health.
5. Quote private pay last. If no program covers the ride, give the price and payment terms before the trip.
6. Write down what you checked. Keep the eligibility result, the plan’s answer, and the broker’s trip number with the trip record. See NEMT trip documentation.

Medicare’s ride rules are federal. Medicaid’s differ by state, so check your state’s NEMT rules and brokers in our state guides.