Interfacility Transport in 2027: When a Wheelchair or Stretcher Van Can Take It and Who Pays

Hospitals move patients between buildings all day: to a scanner across town, to a rehabilitation hospital, to a nursing home. Many of those patients sit in a wheelchair or lie on a stretcher and need no care on the way. That work can fit your vans, but the bill rarely goes where you expect, and a wrong guess means an unpaid trip.

What counts as an interfacility ride

An interfacility ride starts at one health care facility and ends at another. Four kinds come up most, and each one is paid differently:

• A round trip during a stay. An inpatient goes to another hospital or a freestanding center for a test or treatment the first hospital cannot give, then comes back to the same bed.
• A transfer. The patient is discharged from one facility and admitted to another, such as a hospital to a rehabilitation hospital, a nursing home, or a second hospital.
• A move on one campus. A patient goes between buildings of the same hospital.
• A nursing home resident’s trip. A resident goes out to a clinic, a doctor’s office, or a hospital. The nursing home transportation guide covers who pays for those.

Ask the caller three questions before you quote. Is the patient an inpatient right now? Will the patient come back to the same facility? Who is paying? The answers decide who you bill.

Which interfacility rides belong in a van

A van fits only when the patient is stable and needs no medical care on the way. The federal emergency treatment law, EMTALA, draws the hardest line. Under 42 CFR 489.24(e), a hospital may not transfer a patient whose emergency medical condition is not stabilized unless the patient asks in writing or a physician certifies that the benefits outweigh the risks, and the transfer is appropriate. An appropriate transfer includes moving the patient “through qualified personnel and transportation equipment, as required,” with life support measures when they are needed. Stabilized means no material deterioration is likely during the transfer.

The same rule counts a discharge as a transfer. Once a hospital admits an emergency patient as an inpatient in good faith to stabilize the condition, its EMTALA duties end and its Medicare conditions of participation take over. Since July 1, 2025, those conditions require written policies for transferring patients to the right level of care, including to another hospital, with yearly staff training (42 CFR 482.43(c)).

The hospital picks the vehicle. CMS guidance for EMTALA surveyors (State Operations Manual Appendix V, Rev. 191, July 19, 2019) says the physician at the sending hospital decides the mode, equipment, and attendants, and that even emergency medical technicians are not always qualified personnel. So you never make that call, but you can and should turn down a patient your vehicle and staff cannot handle.

Programs draw the line too:

• South Carolina (Modivcare). As of October 2026, a patient who needs a higher level of care at another hospital and is medically unable to wait the 3-hour pickup window is an emergency transport, which Modivcare denies as NEMT.
• Indiana. Since July 1, 2023, fee-for-service members who must travel on a stretcher go by an enrolled ambulance provider, scheduled directly. As of October 2026, Indiana’s fee schedule lists stretcher van code T2005 as not covered.
• Ohio. Under Ohio Revised Code 4766.04, in its current form since August 1, 2018, no one may carry a wheelchair or mobility aid user between hospitals, emergency departments, dialysis centers, nursing homes, surgical facilities, inpatient rehabilitation facilities, memory care centers, health care practitioners’ offices, or other licensed inpatient facilities without an ambulette license. See the Ohio guide.

For where the van ends and the ambulance begins, see NEMT vs ambulance. For what a stretcher van must carry, see the stretcher van glossary entry.

Who pays for each kind of interfacility ride

The patient’s status on the way decides who pays. While the patient is still the first hospital’s inpatient, the ride belongs to that hospital. Once the patient is discharged and headed to a new admission, a program or the patient may pay. Here is how Medicare splits it, as of October 2026:

The ride	The patient on the way	Who pays a van company
Round trip for a test or treatment	Still the first hospital’s inpatient	The admitting hospital, under an arrangement
Move between buildings of one hospital	Still an inpatient	The hospital
Discharge and admission to another facility	A patient of neither facility	Medicaid where the state covers it, the hospital by agreement, or the patient

Why the hospital pays for a round trip

Medicare treats the ride as part of the hospital stay. Its rule on inpatient hospital services, 42 CFR 409.10(a)(8), lists “transportation services, including transport by ambulance.” The Medicare Claims Processing Manual, chapter 3, section 10.4 (manual revision 13757, April 30, 2026), says transportation to and from another hospital or a freestanding facility, for diagnostic or therapeutic services the first hospital lacks, is covered by the hospital’s inpatient payment. The hospital books the ride’s cost as part of the test or treatment itself.

Three rules follow from that:

• The hospital must buy the ride from you. Medicare excludes any service an outside company gives a hospital inpatient unless the hospital has an arrangement with that company (42 CFR 411.15(m)). Under an arrangement, Medicare’s payment to the hospital settles what the patient owes (42 CFR 409.3).
• You cannot bill the patient. The hospital may not charge a Medicare inpatient for services furnished under arrangements, and a charge by you is treated as the hospital’s charge, which is also barred (42 CFR 489.21(f)).
• Moves on one campus count too. CMS calls these trips patient transportation, and they include moves between departments of the same hospital in separate buildings (Claims Processing Manual, chapter 15, section 10.4).

Why a transfer is different

When a patient is discharged from one facility and admitted to another, the patient belongs to neither facility while in transit. Medicare can then pay a separate claim, but only for an ambulance that meets its rules (Benefit Policy Manual, chapter 10, section 10.3.3, revision 13459, November 26, 2025). Medicare pays no claim for an ambulette, wheelchair van, or litter van ride on its own (Claims Processing Manual, chapter 6, section 20.3.1, February 21, 2025). So for a van transfer, your payer is Medicaid where the state covers it, the hospital if it agrees to pay, or the patient. See does Medicare cover NEMT for the rest of the Medicare picture.

A nursing home resident in a covered Part A stay follows the home’s consolidated billing rules, which the nursing home guide explains.

What Medicaid programs say about inpatients

State Medicaid manuals keep inpatient rides with the hospital too:

• New York. The Medicaid transportation manual (effective August 25, 2023) says the hospital’s payment includes all necessary transportation for an inpatient. When the admitting hospital sends an inpatient round trip to another hospital for a test or therapy, it must pay the “ambulance (or other transportation) service,” and Medicaid will not authorize or pay the trip.
• Michigan. The provider manual’s ambulance chapter (October 1, 2026) does not pay for ambulance round trips from a hospital to another facility and back, because all ancillary services are the hospital’s responsibility while the patient is an inpatient.
• Texas. The ambulance handbook (October 2026) puts ambulance rides during an inpatient stay inside the inpatient hospital benefit and does not pay the ambulance company for them.
• Arizona. AHCCCS fee-for-service may pay for a round-trip ambulance ride when a hospitalized member goes elsewhere for specialized care, but only when no other way of traveling is appropriate, the service is not available at the first hospital, the destination is the nearest with it, and the member returns (Chapter 14, revised July 31, 2026). The rule covers only ambulances, and a patient who could ride safely in a van fails its first test.

How Medicaid programs handle transfers between facilities

Transfers, where the patient leaves one facility for good, are where Medicaid may pay you. Each state handles them its own way:

• Indiana. All fee-for-service hospital-to-hospital transports, including wheelchair rides, stay out of the broker program. They are scheduled directly with an enrolled transportation provider, not through Verida, and the claim goes to the state’s claims processor with the HH modifier on the base rate and the mileage. As of October 2026, Indiana pays $31.79 for a wheelchair van trip (A0130) plus $1.67 a mile (A0425 U5), and the base rate rises to $32.71 on January 1, 2027. Verida handles other interfacility rides, such as a hospital to an extended care facility, as urgent trips served within 3 hours of notice, while nursing facilities book and pay for their own residents’ van rides. See the Indiana guide.
• Missouri. The state’s NEMT broker does not arrange hospital-to-hospital transfers. MO HealthNet covers them when its transfer criteria are met and sends providers to its ambulance manual for those criteria (NEMT manual, April 2026).
• South Carolina. As of October 2026, Modivcare covers a hospital-to-hospital ride only when the patient is going for a higher level of care the first hospital lacks. It does not cover moves between hospital buildings of the same system. Hospital staff book discharges around the clock on the facility line, 866-420-6231, and the company assigned has 30 minutes to 3 hours to pick up.
• Virginia fee-for-service. MTM Health lists facility-to-facility and hospital-to-hospital transfers among its urgent rides (member handbook, last updated June 23, 2026). Urgent rides skip the usual 5-business-day notice and can be booked 24 hours a day at 1-866-386-8331.

If your state is not here, read the transportation chapter of its Medicaid manual for the words inpatient, transfer, and hospital to hospital, then ask your broker in writing. The Medicaid billing guide covers codes and modifiers.

How to set up interfacility work with a hospital

For round trips and campus moves the hospital pays, so the hospital is your customer. Set the account up before the first call:

1. Find who books transfers. Ask the case management department who arranges rides to other facilities, and whether its transfer policy names vehicle levels. The hospital discharge guide covers who to call and how fast discharge pickups must be.
2. Agree on the patients you will take. Write down your vehicle types, whether you carry stretchers, your oxygen limits, and the patients you will refuse, such as anyone who needs monitoring on the way.
3. Sign a written agreement for hospital-paid rides. Set the price for round trips, campus moves, and transfers, who signs for each ride, how you invoice, and when the hospital pays. The facility transportation agreement template has the clauses, and the facility contracts guide covers pricing.
4. Confirm the ride type on every call. Note whether the patient is an inpatient and whether they come back. That tells you whether to bill the hospital or a program.
5. Never bill Medicaid or the patient for a round trip during a stay. Send it to the hospital under your agreement.
6. Check the patient at pickup. If the patient is not the one you were told about, call the sending unit before you load.
7. Keep the paperwork. Log the order, the pickup and drop-off times, and who received the patient, on a record you can hand the hospital with your invoice.