How to Bill Medicaid for NEMT in 2027: From Enrollment to Payment

Medicaid pays for a NEMT ride when four things line up: an enrolled provider, an eligible rider, an authorized trip, and a correct claim filed on time. The steps are the same in every state. The forms, codes, and deadlines depend on who pays you.

Who you bill: the state, a broker, or a health plan

Federal rule 42 CFR 440.170(a) lets a state pay transportation providers directly or run NEMT through a broker. Many states also have Medicaid health plans cover rides for their members. That choice decides where your claim goes.

Who pays you	How trips reach you	Where the claim goes	Example
The state (fee-for-service)	The rider or a facility books with you, and the state authorizes the trip where required	The state’s claims system	Arizona AHCCCS fee-for-service. Texas demand response providers bill TMHP (handbook, September 2026).
A broker	The broker assigns each trip with a trip ID	The broker	Verida, Indiana fee-for-service (module published August 19, 2025)
A Medicaid health plan	The plan or the broker it hires assigns trips	The plan or its broker	Blue Cross and Blue Shield of Texas moves its Medicaid rides from Modivcare to MTM Health on October 1, 2026
A mix	The broker authorizes the trip	The state	New York: attest the trip with the broker, then bill eMedNY

One company often bills more than one route. Indiana shows how they combine. Most of its fee-for-service NEMT runs through the broker Verida, and providers must be enrolled with Indiana Medicaid and contracted with Verida. Stretcher, BLS, and ALS trips are booked directly with ambulance providers and billed to the state’s claims contractor, Gainwell. When a rider has a brokered and a nonbrokered trip on the same day, Indiana wants two claims, one to each payer (module version 6.1, published August 19, 2025).

Check your state’s model before anything else. Our state guides and broker directory show who runs NEMT where.

What you need before your first claim

1. Medicaid enrollment. Your state must screen every enrolled provider (42 CFR 455.410) and revalidate each enrollment at least every 5 years (42 CFR 455.414). If you only drive for a Medicaid health plan, the state still has to screen and enroll you, though you do not have to serve fee-for-service riders. The plan may contract with you for up to 120 days while that is pending (42 CFR 438.602(b)). See how to become a Medicaid transportation provider.
2. An NPI on every claim. Federal rule 42 CFR 431.107(b)(5) requires providers who can get an NPI to give it to the state and include it on every Medicaid claim. A company uses a Type 2 (organization) NPI from NPPES. See how to get an NPI number for NEMT.
3. The right taxonomy code. You choose it on your NPI application, and some states check it on claims.
4. Claim submission access. Each state has its own sign-up. New York requires an Electronic/Paper Transmitter Identification Number (ETIN) and a Certification Statement, renewed every year, before it accepts claims on paper or electronically. Arizona takes claims in its online provider portal, as 837P files, or on paper. Texas takes them through TexMedConnect, other software connected to its EDI Gateway, or on paper.
5. Provider and driver checks. Section 1902(a)(87) of the Social Security Act, added by the Consolidated Appropriations Act, 2021, requires each state to make sure NEMT providers and drivers are not excluded from federal health programs and drivers hold valid licenses. Providers also need a process for state drug law violations and for disclosing each driver’s driving history to Medicaid. Check every owner and hire against the OIG exclusion list.

The national taxonomy list (version 26.1, effective July 1, 2026) has these transportation codes:

Taxonomy code	Name in the code set
343900000X	Non-emergency Medical Transport (VAN)
343800000X	Secured Medical Transport (VAN)
344600000X	Taxi
347C00000X	Private Vehicle
342000000X	Transportation Network Company
347B00000X	Bus
347E00000X	Transportation Broker
3416L0300X	Ambulance, Land Transport

States may expect a specific one. Texas’s Medical Transportation Program handbook (September 2026) recommends 343800000X for demand response providers. See NEMT taxonomy codes.

How to bill Medicaid for NEMT, step by step

1. Check eligibility for the date of the ride

Before it pays, the state must confirm that the rider was in its eligibility file and that you were authorized to provide the service on that date (42 CFR 447.45(f)). Check eligibility in your state’s system before each trip, not once a month.

This matters more in 2027. Under the CMS rule issued June 1, 2026, states must generally start a new 80-hour monthly work requirement for many adults in the Medicaid expansion group no later than January 1, 2027. States check it at application and renewal and may check more often, so a rider can lose coverage between trips. See Medicaid work requirements and NEMT.

2. Get the trip authorized before you drive

Programs authorize trips in different ways, and the number usually goes on the claim.

• New York. The broker sends you the trip. After the ride, you attest that it happened, and the state issues an 11-digit prior authorization number for the claim. Attest within 30 days of the date of service. The claim also needs the ordering practitioner’s NPI, or it rejects.
• Texas. The Medical Transportation Program prior authorizes every fee-for-service trip. TMHP’s July 2021 notice says each one-way leg gets its own authorization number and its own claim.
• Arizona fee-for-service. No prior authorization is needed when one member’s total mileage on one date is under 100 miles. Longer days need approval from the AHCCCS Prior Authorization Department.
• Medi-Cal fee-for-service. Non-emergency trips, including wheelchair van and litter van rides, need a Treatment Authorization Request (TAR) with a legible prescription. The modifiers on the TAR and the claim must match. The only exception is a transfer from an acute care hospital to a long-term care facility.
• Brokers. In Indiana, Verida gets any prior authorization its brokered trips need, so you do not request it yourself. Verida gives you a Trip Leg ID when it schedules the ride.

See prior authorization for NEMT.

3. Run the trip and record every leg

Your trip record is the proof behind the claim. New York’s required list, from its Medicaid Transportation Policy Manual (effective August 25, 2023), makes a good checklist for any state:

• The rider’s name and Medicaid ID number
• The date of the ride
• The pickup place and time
• The drop-off place and time
• The vehicle’s license plate number
• The driver’s license number
• The driver’s full printed name and signature
• The driver’s attestation that the trip happened, or a note that the rider did not show

New York accepts an electronic signature and a driver’s tap to confirm the trip. The system must record pickup and drop-off coordinates with a date and time stamp that cannot be changed. Arizona requires its own Daily Trip Report with every NEMT claim and denies claims that arrive without it. Use the free NEMT trip log template, and see NEMT trip documentation requirements.

4. Code the trip

Most NEMT claims have a base line and a mileage line, and some have a wait time line.

• Base rate. One code for the level of service, such as A0130 for a wheelchair van, billed in trips.
• Mileage. Loaded miles, with a code such as S0209 for wheelchair van miles, billed in miles. CMS says empty miles generally cannot be paid, though a state may cover them in limited cases. South Dakota pays some on community transportation trips of 21 miles or more outside city limits, and Arizona bars them.
• Wait time. T2007, in half-hour units, only where your program pays it.
• Extra riders and attendants. Each state bills them its own way. South Dakota adds TK for a second rider, Indiana bills T2004 or adds TT, and T2001 bills an attendant where it is paid.
• Modifiers. Up to four per line, such as TN for rural trips in Arizona, or an origin and destination pair where your state requires one.

Arizona wants every trip for one member on one date on a single claim: base rate on line 1, loaded miles on line 2, and wait time on line 3. A base-only claim and a separate mileage-only claim are denied as split billing. The same code can mean different things in different states, so read NEMT billing codes next to your own fee schedule.

5. Fill out the claim

The CMS-1500 is the standard paper claim, and the 837P is its electronic version, the HIPAA standard under 45 CFR 162.1102. These are the boxes that matter most on a NEMT claim, from the NUCC instructions (version 13.0, July 2025) and state manuals:

Box	What it holds	NEMT notes
1a	Insured’s ID number	The rider’s Medicaid ID, as shown on the card
19	Additional claim information	Arizona (since November 1, 2022) and South Dakota want the pickup and drop-off addresses here. Medi-Cal wants full pickup and drop-off addresses, with city and ZIP code, when you bill mileage, and the time and destination of each trip on round trips and repeat trips the same day.
21	Diagnosis codes	Texas requires Z753 on Medical Transportation Program claims
22	Resubmission code	7 replaces a prior claim and 8 voids one. Leave it blank on first claims.
23	Prior authorization number	No hyphens or spaces
24A	Date of service	The date of the ride
24B	Place of service	Texas recommends 09 on paper claims and uses 99, “other place of service,” in TexMedConnect. Medi-Cal uses 21 when a hospital inpatient rides out and back.
24D	Procedure code and modifiers	The HCPCS code plus up to four two-character modifiers
24F	Charges	South Dakota requires your usual and customary charge. Its fee schedule is the most it pays.
24G	Units	Trips on the base line, loaded miles on the mileage line
24J	Rendering provider NPI	Only when it differs from box 33a
25	Federal tax ID	Your EIN, or SSN for a sole owner
32	Service facility location	Medi-Cal wants the hospital’s address and NPI when a hospital inpatient rides to an appointment and back
33, 33a, 33b	Billing provider, NPI, other ID	33b can hold your taxonomy code after the ZZ qualifier

New York does not use the CMS-1500. Paper claims go on its eMedNY-000201 form (Form A), with the prior authorization number in field 19, place of service 99 in field 20, and the ordering provider’s NPI in field 23. See the box-by-box CMS-1500 guide for NEMT and how to submit NEMT claims electronically.

An Arizona example. A wheelchair rider in Phoenix goes from home to dialysis and back on one date, 12 loaded miles each way. These amounts use AHCCCS fee-for-service rates effective October 1, 2026, and the distances are example numbers.

Line	Box 24D	Box 24G	Rate	Amount
1	A0130	2 trips	$11.15	$22.30
2	S0209	24 miles	$1.54	$36.96
Total				$59.26

The trip starts in the Phoenix metro area, so no TN modifier. The day’s mileage is under 100, so no prior authorization. The Daily Trip Report goes with the claim, and on a paper claim the addresses go in box 19.

6. Submit before the deadline

File daily or weekly, and keep every acceptance and rejection report. They prove you filed on time. Texas lets providers use TMHP rejection reports or Return to Provider letters as proof of meeting its 365-day limit. The next section lists the deadlines.

7. Read the remittance and fix what failed

Each payment comes with a remittance advice, on paper, as a PDF, or as an 835 file. Texas sends a weekly Remittance and Status report. Every denied or reduced line carries a standard adjustment reason code:

Code	What it means (X12)	The usual NEMT fix
16	Claim lacks information or has billing errors	Add the missing item, such as the authorization number or addresses
18	Exact duplicate claim or service	For a second trip the same day, add the modifier your state wants, such as XE in Indiana
27	Expenses incurred after coverage terminated	Check eligibility on the date of the ride
29	The time limit for filing has expired	Appeal only with proof you filed on time
4	Procedure code inconsistent with the modifier	Match the modifiers to the code and the authorization
197	Authorization absent	Get the authorization and resubmit if your state allows
109	Not covered by this payer	Send it to the right payer, such as the rider’s health plan or broker

Send a correction with frequency code 7 in box 22 and the payer’s original claim number. See how to read remittance advice, corrected NEMT claims, and NEMT claim denials.

Medicaid claim deadlines for NEMT

Federal rule 42 CFR 447.45(d)(1) requires every state to make providers submit claims within 12 months of the date of service. States can set shorter limits, and many do. See Medicaid timely filing limits.

Payer	First claim due	Fixes and appeals	Source date
Federal ceiling	12 months from the date of service		42 CFR 447.45
New York Medicaid	90 days from the date of service. Attest the trip within 30 days.	With retroactive eligibility, attest up to 120 days after eligibility is set	Billing guidelines, August 5, 2026
Texas Medical Transportation Program	95 days from the date of service, 365 days for out-of-state providers	New providers: 95 days from getting their provider identifier and 365 days from the ride	Handbook, September 2026
Arizona AHCCCS fee-for-service	6 months after the date of service	Clean claim or corrections within 12 months	Chapter 4, revised November 3, 2025
Medi-Cal fee-for-service	6 months after the month of service	Months 7 to 9 pay 75 percent and months 10 to 12 pay 50 percent. After that, denied. Appeal within 90 days of the remittance.	Provider manual pages updated February and May 2025
South Dakota Medicaid	6 months after the month of service	Reconsideration within the filing period or 3 months after a denial	Manual, updated August 2026

How long Medicaid takes to pay

The federal payment standard is written for practitioners: 90 percent of their clean claims paid within 30 days of receipt and 99 percent within 90 days. All other claims must be paid within 12 months of receipt (42 CFR 447.45(d)). A clean claim is one the state can process without asking you or anyone else for more information.

Health plan contracts must hold plans to the same 30-day and 90-day standard, unless the plan and its providers agree to a different schedule written into the contract (42 CFR 447.46). Texas pays Medical Transportation Program claims weekly. Broker contracts set their own schedules. See how long Medicaid takes to pay.

Billing a broker instead of the state

In a broker program, the broker holds the Medicaid contract and pays you from its own rate sheet. You submit claims in its portal, tied to its trip ID.

Indiana’s fee-for-service broker, Verida, shows how it works (module published August 19, 2025):

• Joining. You sign Verida’s provider agreement and rate agreement, and finish its credentialing within 60 days.
• Rates. Verida’s rate schedule is based on the state’s Professional Fee Schedule, and Verida may negotiate higher or special rates with each provider.
• Payment. Clean claims sent to Verida by Wednesday are paid within 14 days, by check or direct deposit, with a remittance advice for each payment cycle.
• Disputes. Start with an administrative review in Verida’s provider portal, then file a written appeal if that does not settle it.

Your state enrollment still matters in many broker states. Indiana requires providers in the Verida network to be enrolled Indiana Medicaid providers too. For trip IDs, portals, payment cycles, and appeals at each major broker, see how to bill NEMT brokers.

Billing a Medicaid health plan

When a rider is in a Medicaid managed care organization, the plan decides who carries and pays for the ride. In Texas, health plans approve managed care NEMT, and the state’s Medical Transportation Program handbook does not apply to their members.

Many plans hand rides to a broker. Blue Cross and Blue Shield of Texas moves its Medicaid members from Modivcare to MTM Health on October 1, 2026. Its August 26, 2026 notice says recurring and already scheduled trips after that date go to MTM Health. A change like that moves your claims too. Ask each plan three questions: which broker handles its rides, where claims go, and what its filing deadline is.

The federal rules still apply. The state must screen and enroll you as a plan network provider (42 CFR 438.602(b)), and the plan’s contract sets its payment schedule under 42 CFR 447.46.

Rules every Medicaid NEMT claim must follow

• Medicaid’s payment is payment in full. Under 42 CFR 447.15, you accept what Medicaid pays plus any cost sharing the state plan allows. CMS’s transportation guide (September 28, 2023) says NEMT cost sharing is allowed only when the state covers NEMT as an optional medical service, and it must be nominal.
• No claims for no-shows where the state forbids them. Texas says providers cannot bill Texas Medicaid or Medicaid clients for missed appointments. See billing for NEMT no-shows.
• Loaded miles, as a rule. CMS’s transportation guide says miles with no rider on board generally cannot be paid, though states may build them into rates or cover them in limited cases with CMS approval. Arizona bars any claim for unloaded mileage, including a trip to pick up a member’s prescription. See loaded miles.
• Payment goes to you. 42 CFR 447.10 bars Medicaid payments to or through a factoring company. A billing agent may receive payment in your name only if its fee is tied to the cost of billing and not to what it collects. See NEMT factoring.
• Medicare does not pay NEMT van codes. The CMS HCPCS file (October 2026) marks A0130, T2003, S0209, and the other non-emergency transportation codes as not payable by Medicare.
• Other coverage comes first. When the state has already found that another insurer is probably liable, it generally must reject the claim and return it to you so that insurer’s share is settled first (42 CFR 433.139). See third party liability.
• Keep the records. Every provider agreement requires you to keep records of the services you give and to hand them over on request (42 CFR 431.107). New York requires each leg’s trip record for 6 years from the date of payment.

What auditors find in NEMT claims

The HHS Office of Inspector General audits state NEMT programs, and its findings show what a weak record costs. In a September 2022 audit of New York City NEMT payments for 2018 and 2019 (report A-02-21-01001), only 17 of 100 sampled payments met federal and state rules. Another 41 did not, and for 42 the auditors could not tell. Among the problems:

Finding in the New York audit	Sampled payments	Result
No valid practitioner’s order behind the authorization	22	Unallowable
Trip not adequately documented (date, pickup, drop-off, driver, or vehicle missing, or no record at all)	13	Unallowable
Driver qualification rules not met	7	Unallowable
No proof the vehicle met inspection and licensing rules	21	Could not be confirmed
No proof the driver was licensed for the vehicle	10	Could not be confirmed

OIG estimated that New York improperly claimed at least $84,329,893 in federal Medicaid money for payments that did not meet the rules. On May 28, 2026, OIG announced a new series of audits of NEMT payments in selected states. Its notice names the basics it will test against: prior authorization backed by a practitioner’s order, providers lawfully allowed to transport, and records that support each service.

Build your files so any claim can be proven years later:

1. Keep one record per leg with every field your state lists, and match it to the claim line.
2. File the authorization with the trip record, including the practitioner’s order where your state requires one.
3. Keep dated copies of vehicle inspections, registrations, and permits that cover every date you billed.
4. Keep each driver’s license, driving record, and exclusion checks current and on file.
5. Audit yourself. Pick 10 paid claims a month and check each against its trip record, authorization, driver file, and vehicle file.