# NEMT Multiloading in 2027: Ride-Time Limits, Safety, and How Each Payer Pays for Shared Rides

Canonical URL: https://nemtguide.com/guides/nemt-multiloading/ · Updated 2026-09-29

NEMT multiloading means carrying two or more riders with separate trips in one vehicle at the same time. Most programs allow it within ride-time limits, such as 45 minutes over the direct trip with MTM Health and Georgia Medicaid and one hour in Texas. Pay differs by payer: Arizona pays each rider's own miles, New York and Illinois pay the miles once, and Colorado allows almost no shared rides.

- A shared ride has to fit every rider on board: extra time in the van, arrival window, level of service, and a seat or securement position.
- Ride-time caps run from 45 minutes over the direct trip with MTM Health and Georgia to one hour in Texas and Louisiana.
- Most payers pay the vehicle's miles once. Arizona is the exception and pays each rider's own direct miles.
- Colorado bars carrying two members at once, except family members its rule lets ride along, and then bills one member only.
- Keep a complete trip record for each rider, under the same driver and vehicle.

Two riders headed to the same dialysis center at the same hour can share one van instead of taking two. That can save a driver, a vehicle, and a set of miles. Whether it also makes money depends on two things you do not control: the ride-time limit in your broker agreement and the way your payer pays for the second rider.

## What multiloading means in NEMT

Multiloading, also called a shared ride or a multi-load, is carrying two or more riders with separately booked trips in one vehicle at the same time. CareOregon's provider manual (February 2024) defines a shared ride as more than one member's trip assigned to a provider at once, to be transported at the same time. Texas defines it more tightly: members traveling in the same direction with appointments scheduled within one hour of each other.

Shared rides come from two places:

- **The broker.** MTM Health's Rhode Island handbook (updated July 1, 2026) says its system identifies routing and multi-loading opportunities before a trip is assigned to a provider.
- **You.** New York's Medicaid transportation manual (effective August 25, 2023) sets rules for rides grouped by the transportation provider. MAS, New York's Medicaid transportation broker, says it supports providers who multi-load riders going to the same or nearby locations.

Riders are told to expect it. Georgia's Medicaid NEMT page tells members that NEMT is a ride-share program and other members may be riding in the same vehicle. MTM Health, which takes over Virginia fee-for-service trips on October 1, 2026, asks members in its handbook (approved August 10, 2026) to be thoughtful of the passengers they share a ride with.

A shared ride is different from a rider bringing a companion or an escort. A companion rides on the member's trip. Programs that pay for one bill it on the member's claim, as Indiana does with TK on a wheelchair trip. See the [TK modifier](https://nemtguide.com/glossary/tk-modifier/) for how escorts and extra riders are coded.

## When two riders can share a van

Before you pair two trips, check that the shared ride works for each rider on board, not just for the schedule.

1. **Same direction, close times.** Texas's one-hour test is a good rule anywhere: appointments within an hour of each other, heading the same way.
2. **Each rider still arrives on time.** Texas requires arrival at least 15 minutes and no more than one hour before the appointment, unless the member asks. Louisiana allows 15 minutes to two hours early. MTM Health in Virginia requires drop-off no later than the appointment time. A pairing that drops one rider three hours early breaks the Texas and Louisiana rules, and one that gets a rider there after the appointment breaks Virginia's.
3. **Each pickup stays inside its window.** MTM Health in Virginia counts a first-leg pickup on time from 15 minutes before to 15 minutes after the scheduled time, and each rider on a shared run has their own window.
4. **There is a seat or securement position for everyone.** Medi Trans, the broker for Louisiana Healthcare Connections, caps occupants, driver included, at the manufacturer's seating capacity (manual revised February 20, 2025). Virginia's member handbook (June 2026) requires each wheelchair to face forward with four securement straps plus a lap and shoulder belt, so two wheelchair riders need two full positions. See [wheelchair securement](https://nemtguide.com/guides/wheelchair-securement/).
5. **The driver can still give each rider the assistance on the trip.** MTM Health in Virginia warns that transporting a member in a way that does not match the authorized level of assistance may bring nonpayment or corrective action.
6. **Only authorized people ride.** Medi Trans bars carrying more people than it authorized. Virginia members must report an extra passenger when they book so there is room.
7. **Nothing on the trip rules out sharing.** Virginia asks members to report special needs at booking, such as behavioral issues during transportation, oxygen, or IVs. If a manifest shows something that makes a shared ride unsafe, ask the broker before you pair it.

Colorado mostly does not allow shared rides. Its Medicaid rule (10 CCR 2505-10, section 8.014.3.D, in the version effective July 10, 2026) bars NEMT providers from carrying more than one member at a time unless the extra passenger is an escort. The other exceptions are family ones: a member's children or an at-risk adult in the member's care, a member's siblings riding with the escort, or the escort's own children or an at-risk adult in the escort's care, each only when no other care is available for the trip. On those trips you bill one member ID, list every passenger's name on the trip report, and may turn the trip down if your vehicle cannot fit everyone.

## Ride-time limits on a shared ride

Each program below caps the extra time a shared ride adds. The cap is measured against each rider's direct trip, so the rider picked up first and dropped off last usually carries the most. See maximum ride time for how the limit works on single rides.

| Program | Limit on a shared ride | Measured against |
|---|---|---|
| MTM Health, Virginia fee-for-service, from October 1, 2026 (handbook approved August 10, 2026) | 45 minutes longer, unless specifically authorized | The average direct travel time between pickup and destination |
| MTM Health, Rhode Island (updated July 1, 2026) | 45 minutes longer | The average travel time for direct transport |
| MTM, general provider handbook (August 2022) | 45 minutes longer | The same trip not multi-loaded |
| Georgia Medicaid (July 1, 2026) | 45 minutes longer | The average travel time for direct transport |
| Medi Trans, Louisiana Healthcare Connections (February 20, 2025) | 45 minutes longer | The direct curb-to-curb travel time |
| Texas Medicaid health plans (August 1, 2021) | 1 hour longer | The average travel time for direct transport of that member |
| Louisiana Medicaid (July 14, 2025) | 1 hour beyond, on every ride | The estimated travel time |
| MAS, New York (October 1, 2023) | Rides under 1 hour, with some exceptions | The length of the ride |

Virginia's member handbook (June 2026) sets the same limit today, in plain terms: drivers must transport the member within the approved travel time, which is the direct travel time plus 45 minutes.

### How to check a shared ride against the limit

**Extra ride time = minutes the rider is on board − that rider's direct travel time**

Here is a hypothetical run under a 45-minute cap. Rider A's direct trip to the clinic is 25 minutes, and A is picked up first. The detour to Rider B adds 12 minutes of driving and 8 minutes to load B's wheelchair. A is on board 45 minutes, so A's extra time is 20 minutes. That passes.

Add Rider C, whose pickup adds another 30 minutes. A is now on board 75 minutes, 50 over the direct trip. That breaks the cap with MTM Health and Georgia, though it would still pass the one-hour limit in Texas. Drop C, or pick C up first and check again.

## How each payer pays for the extra rider

This is where shared rides differ most. Some payers pay each rider in full, some cut the second rider's base rate, and some pay the vehicle's miles only once.

| Program | When the rule applies | Base rate for each rider | Mileage |
|---|---|---|---|
| Arizona fee-for-service (manual revised July 31, 2026) | Any members in the same vehicle | Each member has their own Daily Trip Report and claim | Each member's own most direct route. Wait time is paid for one member only. |
| New York Medicaid (manual effective August 25, 2023) | More than one Medicaid rider in the vehicle at the same time | A base fee for each rider | Once, from the first pickup to the last drop-off |
| Illinois Medicaid (handbook March 11, 2024) | More than one customer in the vehicle | A full base rate, and any approved attendant, for each rider on separate claims | First rider picked up only, on that rider's direct route |
| Indiana Medicaid (module version 6.1; rates January 1, 2026) | Two or more members from the same county to the same vicinity | First member full. Later members half: T2004 at $6.36 against T2003 at $12.71, and A0130 TT at $15.90 against A0130 at $31.79. | First member only, with no waiting time for the others |
| South Dakota Medicaid (fee schedule July 1, 2026) | Each additional South Dakota Medicaid rider | TK at 50 percent: secure van A0130 TK $21.70 against $43.39, in-city community transport A0120 TK $2.60 against $5.20 | One allowance per trip, billed on one rider's claim |
| Medi-Cal fee-for-service (rate page updated September 2023) | Riders picked up at the same point and taken to the same destination | A lower base per patient: $16.22 each for two (UN), $12.85 for three (UP), $11.51 for four or more (UQ, UR, US), against $20.30 for one | A0380 mileage on one claim only |
| Colorado (10 CCR 2505-10, section 8.014.3.D, July 10, 2026) | Only when family members the rule allows ride along; other shared rides are not allowed | Only one member's ID may be billed | One claim for the trip |
| MTM Health, Virginia and Rhode Island (2026) | Broker trips | Priced from MTM's Schedule A rate sheet, which reflects mileage, mode of transportation, and multiloading | Included in the same rate sheet |

A few details change the money:

- **Indiana** pays nothing extra for multiple passengers if you do not bill your other customers for them. It also deducts the first 10 miles of each one-way wheelchair or walk-on trip before paying mileage. Most Indiana fee-for-service trips are brokered by Verida and billed to Verida, so check its rate terms for those.
- **New York** counts people who live together at one address and go to the same destination as one trip with an additional rider, not two paid trips. That rule does not cover separate apartments in one building, adult homes, or nursing facilities. Tolls are billed once per crossing for the vehicle, not per rider.
- **New York City** trips that begin and end in New York State and begin in, end in, or pass through Manhattan south of 96th Street carry a state congestion surcharge. As of the tax department's update of December 30, 2025, it is $2.75 for a single for-hire trip or $2.50 in a medallion taxi, but $0.75 per rider on a pool trip, which New York Medicaid applies to shared rides. Medicaid pays it back under A0170, with TU for a single trip and TK for each pool rider. Ambulances and ambulettes are exempt.
- **Colorado** moves every Medicaid NEMT trip to one statewide broker, MediDrive, on January 1, 2027. From then on, all trips are scheduled and paid through MediDrive, so check its contract for trips that carry more than one member.

In any broker program, your broker's rate sheet sets the pay. The state rules above show how each state pays when it pays you directly. For how miles are counted in general, see [NEMT mileage billing](https://nemtguide.com/guides/nemt-mileage-billing/) and [loaded miles](https://nemtguide.com/glossary/loaded-miles/).

### The national modifier codes

The CMS HCPCS file for October 2026 lists the codes payers use for shared rides. Each payer decides which ones it accepts.

| Code | National description | Used for shared rides in |
|---|---|---|
| TK | Extra patient or passenger, non-ambulance | South Dakota, and New York on A0170 for the pool congestion surcharge |
| TT | Individualized service provided to more than one patient in same setting | Indiana, on A0130 and taxi codes |
| UN, UP, UQ, UR, US | Two, three, four, five, and six or more patients served | Medi-Cal, on A0130 |
| [T2004](https://nemtguide.com/glossary/t2004/) | Non-emergency transport; commercial carrier, multi-pass | Indiana, for second and later walk-on riders |
| GM | Multiple patients on one ambulance trip | Ambulance claims, not NEMT vans |

## What a shared ride pays: one ride, three rule sets

Here is a hypothetical example. Two wheelchair riders from the same county have the same appointment time at one dialysis center. Rider 1 lives 12 miles from the center. Rider 2 lives 8 miles away, right on Rider 1's route. The van picks up Rider 1, then Rider 2, and drives 12 loaded miles. Two separate trips would cover 20 loaded miles.

| Program and rates | The shared ride pays | Two separate trips pay | Shared as a share of separate |
|---|---|---|---|
| Arizona fee-for-service, urban trips (October 1, 2026): A0130 $11.15 base, S0209 $1.54 a mile | $53.10 | $53.10 | 100% |
| Illinois, most counties outside the Chicago and St. Louis areas (January 1, 2026): medicar A0130 $30.00 base, A0425 $0.80 a mile | $69.60 | $76.00 | 92% |
| Indiana, trips billed to the state (January 1, 2026): A0130 $31.79, A0130 TT $15.90, A0425 U5 $1.67 a mile after the first 10 miles | $51.03 | $66.92 | 76% |

How the shared ride adds up in each program:

- **Arizona:** each rider's base plus their own direct miles. Rider 1 is $11.15 + (12 × $1.54) = $29.63, and Rider 2 is $11.15 + (8 × $1.54) = $23.47.
- **Illinois:** two base rates, and the miles for the first rider picked up. That is $30.00 + (12 × $0.80) = $39.60 for Rider 1 and $30.00 for Rider 2.
- **Indiana:** Rider 1 gets the full base plus 2 paid miles, $31.79 + (2 × $1.67) = $35.13. Rider 2 gets A0130 TT, $15.90. On a separate trip, Rider 2's 8 miles fall inside the unpaid first 10.

The shared ride uses one van, one driver, and 12 loaded miles instead of 20. In Arizona it pays the same as two trips and saves the miles and the time. In Illinois it pays $6.40 less than two trips, and in Indiana $15.89 less, so there it only makes sense if the saved miles and driver time are worth more than that. Put your own cost per mile and per driver hour next to these numbers before you decide, and count the [deadhead miles](https://nemtguide.com/glossary/deadhead-miles/) to each pickup too.

## Records for every rider on board

A shared ride is still one trip per rider on paper. Each record has to stand on its own if an auditor pulls it.

- **MTM Health, Virginia and Rhode Island (2026).** Each claim needs an electronic trip log with the trip ID, scheduled and actual pickup times, departure and arrival times, and the member's signature, or it is denied.
- **Arizona (July 31, 2026).** A separate Daily Trip Report for each member, showing that member's pickup and drop-off and the odometer miles of that member's most direct route. The form asks whether multiple members rode in the vehicle and whether any had a different pickup or drop-off.
- **Georgia (July 1, 2026).** The driver's daily manifest lists each member with the scheduled and actual times and the odometer readings at pickup and drop-off.
- **Medi-Cal.** Each claim for a shared trip needs a separate attachment with the names and Medi-Cal ID numbers of the other riders. When riders share a pickup point and destination, each authorization request (TAR) must list every rider on the trip.

Keep every rider on the shared ride under the same driver and the same vehicle. MTM Health's Virginia handbook scores overlapping claims, trips where one driver shows in two vehicles or two drivers in one vehicle at the same time, and expects them on fewer than 0.99 percent of trips. A shared ride logged under two drivers looks like one. See [NEMT trip documentation](https://nemtguide.com/guides/nemt-trip-documentation/) and the [trip log template](https://nemtguide.com/templates/nemt-trip-log-template/).

## Privacy and conduct with other riders on board

A second rider in the van means someone else can see and hear what your driver does. CareOregon's manual (February 2024) sets simple rules that work in any program:

- Keep papers and screens with member information out of sight of other passengers.
- Do not read a member's information where other riders can see it.
- Do not talk about a member's information by phone or radio in front of others.
- Never share a member's appointment or diagnosis with anyone outside the member's care team.

In practice, have dispatch give the driver addresses, not the type of clinic, when other riders can hear. See [HIPAA for NEMT providers](https://nemtguide.com/guides/hipaa-for-nemt/) for the full rules.

Riders have duties too. MTM Health's Virginia handbook tells members never to physically or verbally abuse other members or the driver. If a rider's behavior makes a shared ride unsafe, report it to the broker and ask for that rider's trips to run alone.

## How to plan a shared run, step by step

1. **Pull tomorrow's trips** and sort them by destination and appointment time.
2. **Pair trips going the same way** with appointments within about an hour of each other.
3. **Check seats and securement.** Count seats and wheelchair positions, driver included, against the vehicle's capacity.
4. **Order the pickups** so the first rider on board stays inside the ride-time cap, then check every other rider.
5. **Check each rider's pickup window and arrival window.** A shared ride that saves 20 minutes but drops someone too early or too late fails.
6. **Check the payer's rule** in the table above before you count the money.
7. **Run it and record each rider separately,** with actual times, odometer readings, and signatures.
8. **Compare the actual extra minutes with the cap** once a week, and stop pairing any trips that keep running over.

For building the rest of the day around shared rides, see [NEMT route planning](https://nemtguide.com/guides/nemt-route-planning/) and [NEMT vehicle utilization](https://nemtguide.com/guides/nemt-vehicle-utilization/). For recurring shared runs to the same center, see [dialysis transportation](https://nemtguide.com/guides/dialysis-transportation/).

## Frequently asked questions

### Is multiloading allowed in NEMT?

Yes, in most programs. Georgia's Medicaid NEMT page tells members that NEMT is a ride-share program and other members may ride in the same vehicle. MTM describes its system as looking for multi-loading opportunities before it assigns trips, and MAS in New York supports providers who multi-load riders going to the same or nearby places. Colorado is the exception: its rule bars carrying more than one member at a time except an escort or certain family members.

### How much longer can a rider stay in the van on a shared ride?

As of September 2026, Virginia fee-for-service, MTM Health in Rhode Island, Georgia Medicaid, and Medi Trans in Louisiana allow 45 minutes over the direct travel time. Texas Medicaid health plans allow one hour over the average direct trip. Louisiana Medicaid caps every ride at one hour beyond the estimated travel time, and MAS in New York expects rides under one hour, with some exceptions.

### Do I get paid for every rider on a shared ride?

It depends on the payer. Arizona fee-for-service pays each member's base and direct miles. Illinois pays a full base for each rider but mileage for the first only. Indiana pays half the base for the second and later riders from the same county to the same area. South Dakota pays 50 percent with the TK modifier. Colorado allows two members in one vehicle only when family members ride along, and then bills one member.

### Can I bill mileage for each rider?

Usually not. New York pays mileage once, from the first pickup to the last drop-off. Illinois pays mileage for the first rider picked up, South Dakota allows one mileage charge per trip, Medi-Cal puts mileage on one claim, and Indiana pays mileage for the first member only. Arizona is the exception: each member's trip report carries that member's own direct-route miles.

### What modifier do I use for the second rider?

Only the one your payer lists. South Dakota uses TK at 50 percent of the base. Indiana uses TT on A0130 for a second wheelchair rider and bills T2004 for a second walk-on rider. Medi-Cal uses UN for two patients, UP for three, and UQ, UR, or US for more. Arizona and Illinois bill each rider on their own claim with no shared-ride modifier. New York uses TK only on A0170, for the congestion surcharge on a pool trip.

### Can a family member ride along on a shared ride?

Usually, if the broker knows in advance and there is a seat. Virginia's fee-for-service program lets a member bring one extra person, reported when the ride is booked. Illinois lets extra passengers ride as a courtesy at no charge, and Medi Trans in Louisiana bars charging for companions and carrying more people than it authorized. A companion is not a second billable rider.

## Official resources

- [New York State Medicaid Transportation Policy Manual (rides grouped by the provider)](https://www.emedny.org/ProviderManuals/Transportation/PDFS/Transportation_Manual_Policy_Section.pdf)
- [Indiana Health Coverage Programs: Transportation Services module (multiple passengers)](https://www.in.gov/medicaid/providers/files/modules/transportation-services.pdf)
- [AHCCCS: Fee-For-Service Provider Billing Manual, Chapter 14 Transportation](https://www.azahcccs.gov/PlansProviders/Downloads/FFSProviderManual/FFS_Chap14Transportation.pdf)
- [Colorado HCPF: NEMT Billing Manual](https://hcpf.colorado.gov/nemt-billing-manual)
- [South Dakota Medicaid: Transportation Services Fee Schedule](https://dss.sd.gov/docs/medicaid/providers/feeschedules/Other_Services/Transportation_Services_Current.pdf)
- [CMS: HCPCS quarterly update files](https://www.cms.gov/medicare/coding-billing/healthcare-common-procedure-system/quarterly-update)