# NEMT No-Show Cost Calculator (2027): What Missed Rides Cost You Each Month

Canonical URL: https://nemtguide.com/tools/nemt-no-show-cost-calculator/ · Updated 2026-09-29

This calculator shows what rider no-shows and late cancellations cost your NEMT company. For each one, it adds the miles and driver time spent getting there and waiting to the trip pay you lose, less any no-show fee a payer pays you. Then it multiplies by your no-shows a month. With the example numbers, 20 no-shows cost $61 each, $1,220 a month, and $14,640 a year.

- Cost of one no-show = the miles and driver time spent getting there and waiting, plus the pay the ride would have brought in.
- In the example, $16 of the $61 is money spent for nothing and $45 is pay not earned, so filling the empty slot matters most.
- Federal Medicaid funds do not pay for a ride the rider missed, and the Medicaid rider cannot be charged for it.
- Wisconsin logged 8,566 member no-shows against 301,246 completed trip legs in May 2026, about 3 for every 100.
- Every no-show you prevent each month is worth up to $732 a year at the example numbers.

Use the calculator on the web page: https://nemtguide.com/tools/nemt-no-show-cost-calculator/

## What the no-show cost calculator does

A [no-show](https://nemtguide.com/glossary/no-show/) is a ride where your driver arrives on time, waits the full time, and the rider is not there or will not get in. A [late cancellation](https://nemtguide.com/glossary/late-cancellation/) that reaches you after the driver has set out costs you the same way. Each one costs you twice:

- **Money you spend.** The miles to the pickup and on to the next stop, and the driver's time driving and waiting at the door.
- **Pay you do not earn.** The ride would have paid you. A no-show pays nothing in most Medicaid programs.

The calculator adds both parts for one no-show, takes off any no-show fee a payer pays you, and multiplies by your no-shows a month. It also shows the miles and driver hours your no-shows use up.

Use it to see what no-shows cost before you spend time or money on reminder calls, to set a private-pay no-show fee, and to bring a real number to rate talks with a broker.

## How to use the calculator

1. Count last month's rider no-shows from your trip records. Add the late cancellations that came after the driver set out.
2. Enter the average miles each one cost: out to the pickup, then on to the next stop or back to base.
3. Enter the average minutes each one took: the drive out plus the wait at the door.
4. Enter your vehicle cost per mile and your driver cost per hour.
5. Enter what the missed ride would have paid you, and any no-show fee your payer pays. Enter 0 if it pays nothing.

The results change as you type. **Reset to example** brings back the example numbers, and **Show the formula** lists each step of the math. If the no-show fee is more than the trip pays, the calculator asks you to check both numbers.

## What each number means

| Box | What to enter | Where to find it |
|---|---|---|
| No-shows a month | Rider no-shows, plus late cancellations after the driver set out | Trip records, or the no-shows you marked in the broker's portal |
| Miles per no-show | Miles driven for nothing, out to the pickup and on to the next stop | Odometer or GPS readings for a few no-shows, averaged |
| Minutes per no-show | The drive out plus the wait at the door | GPS times, or the drive time plus your broker's required wait |
| Vehicle cost per mile | Fuel, tires, and repairs for each mile | A month of those costs ÷ the miles driven that month |
| Driver cost per hour | Hourly pay plus payroll taxes and benefits | Payroll records |
| Average pay per trip | What the missed ride would have paid, mileage included | Remittance advice or broker payment reports |
| No-show fee paid to you | What the payer pays when a rider does not show | Your broker agreement's rate sheet, or your state manual |

### Minutes per no-show and the required wait

Your driver cannot mark a no-show the moment they pull up. The state or broker sets how long they wait:

| Program | Wait before a no-show |
|---|---|
| Texas Medicaid health plans (NEMT Services Handbook, version 2.0.1, effective August 1, 2021) | At least 10 minutes after the scheduled pickup time, after telling the member the ride has arrived |
| Georgia Medicaid (NEMT manual, version date July 1, 2026) | The driver need not wait more than 10 minutes after the scheduled pickup time |
| New York Medicaid (transportation manual effective August 25, 2023) | At least 15 minutes after the scheduled pickup time |
| MediTrans in Louisiana (provider page, September 2026) | 15 minutes at a home and 20 at a facility, then a call to the member and to dispatch |

Add the drive out to the wait. A 15-minute drive and a 15-minute wait make the example's 30 minutes. All of it is paid work for an employee driver. Federal wage rules count travel from job site to job site during the workday (29 CFR 785.38) and time spent waiting on the job (29 CFR 785.15) as hours worked. The [driver cost calculator](https://nemtguide.com/tools/nemt-driver-cost-calculator/) works out what an hour of your driver costs.

### Miles per no-show

Count the whole empty loop: from where the van was to the pickup, and from the pickup to the next stop. CMS counts the driver's return trip after a no-show as unloaded miles, which generally cannot be paid (SMD 23-006, September 28, 2023). In vehicle cost per mile, enter only the costs that rise with each mile: fuel, tires, and repairs. In the [cost per mile calculator](https://nemtguide.com/tools/nemt-cost-per-mile-calculator/), enter 0 for insurance and the vehicle payment to get that number. The [deadhead cost calculator](https://nemtguide.com/tools/nemt-deadhead-cost-calculator/) prices a whole day of empty miles.

### Average pay per trip and the no-show fee

Enter what the missed ride would have paid: the base rate plus the loaded miles. When a rider misses the ride to an appointment, the ride home is usually canceled too. If most of your no-shows are the first leg of a round trip, enter what both legs would have paid.

For the fee, enter what your payer actually pays for a no-show. In most Medicaid programs that is nothing:

| Payer | What it pays for a rider no-show |
|---|---|
| Federal Medicaid funds (CMS SMD 23-006, September 28, 2023) | Nothing. Federal matching funds are not available for transportation to a member who does not appear for the ride. |
| Illinois Medicaid (handbook, March 11, 2024) | Nothing. "No Show" trips, where the patient is not transported, are not paid. |
| MTM Health in Missouri (provider page, September 2026) | Nothing. MTM does not reimburse providers for no-shows, including a rider who cancels at the door. |
| Georgia Medicaid (NEMT manual, version date July 1, 2026) | The broker pays the "A" leg of the trip, if the provider arrived on time |
| Medi-Cal fee-for-service (ground transportation manual, page updated August 2020) | A dry run: the base code (such as A0130 for a wheelchair van) with modifiers DS and QN, on a trip with an approved Treatment Authorization Request. No mileage is paid for the empty run. |

CMS also says states may build the cost of no-shows into their trip rates. Where money for no-shows exists at all, it usually sits inside the rate on the trips you complete. The guide to [billing for no-shows](https://nemtguide.com/guides/billing-for-no-shows/) covers each program's rules.

Never charge the Medicaid rider. CMS says states and providers may not impose a charge on a member for a no-show, and a Medicaid provider accepts the program's payment as payment in full (42 CFR 447.15).

## A worked example

The calculator opens with example numbers. The 30 minutes is a drive out plus a wait like the ones in the table above. The rest are round numbers that show the math, not market rates, so replace them with your own.

| Step | Math | Result |
|---|---|---|
| Vehicle cost of one no-show | 10 miles × $0.60 | $6.00 |
| Driver cost of one no-show | 30 minutes ÷ 60 × $20 | $10.00 |
| Vehicle and driver cost of one no-show | $6.00 + $10.00 | $16.00 |
| Trip pay lost on one no-show | $45 minus a $0 no-show fee | $45.00 |
| Cost of one no-show | $16.00 + $45.00 | $61.00 |
| What no-shows cost a month | $61.00 × 20 no-shows | $1,220 |
| Trip pay lost a month | $45.00 × 20 | $900.00 |
| Vehicle and driver cost a month | $16.00 × 20 | $320.00 |
| Miles driven for no-shows a month | 10 × 20 | 200 miles |
| Driver hours lost a month | 30 minutes × 20 ÷ 60 | 10 hours |
| What no-shows cost a year | $1,220 × 12 | $14,640 |

The $61 has two parts, and they answer different questions.

- **The $16 of vehicle and driver cost** is what the no-show wasted compared with a rider who canceled in time. It is money spent for nothing, and it is certain.
- **The $45 of trip pay lost** is what the ride would have brought in. It is pay, not profit, because the ride itself would have cost you loaded miles and driver time. If dispatch fills the slot with another ride, much of it comes back.

The headline adds the two. Read $1,220 a month as the high end of what no-shows cost you, and the $320 a month of miles and driver time as the floor.

## How many no-shows to expect

Your own trip records are the number that counts, because no-show rates change with your riders, your area, and the kind of appointments you serve. For scale, here is Wisconsin's statewide NEMT program in 2026, from the monthly reports the Wisconsin Department of Health Services posts. The reports count a member no-show as a trip where the member does not use the scheduled service.

| Month in 2026 | Completed trip legs | Member no-shows | No-shows for every 100 completed legs | Canceled trip legs |
|---|---|---|---|---|
| January | 302,649 | 8,850 | 2.9 | 110,215 |
| February | 289,915 | 8,654 | 3.0 | 101,345 |
| March | 307,394 | 9,329 | 3.0 | 115,285 |
| April | 312,164 | 9,444 | 3.0 | 111,587 |
| May | 301,246 | 8,566 | 2.8 | 104,602 |

That is about 3 member no-shows for every 100 completed legs. At that rate, a van running 12 trips a day for 22 days, 264 legs a month, would see about 8 no-shows a month.

Cancellations were far more common: over a third as many as the completed legs. A cancellation that comes before the van leaves costs no miles or driver time, only the open slot. Count only the ones that came after your driver set out.

## What cutting no-shows is worth

At the example's $61 a no-show, here is what the count does to the total:

| No-shows a month | Cost a month | Cost a year |
|---|---|---|
| 5 | $305.00 | $3,660 |
| 10 | $610.00 | $7,320 |
| 20 | $1,220 | $14,640 |
| 40 | $2,440 | $29,280 |

Every no-show you prevent each month is worth up to $732 a year at these numbers. A no-show fee only reduces the pay lost:

| No-show fee paid to you | Cost of one no-show | 20 no-shows a month |
|---|---|---|
| $0 | $61.00 | $1,220 |
| $15 | $46.00 | $920.00 |
| $45, the full trip pay | $16.00 | $320.00 |

Even a fee as large as the trip pay leaves the $16 of miles and driver time.

## How to use the answer

- **Confirm rides the day before.** MTM Health's Missouri page asks providers to confirm the pickup time with the rider the day before, and to cancel the trip if the rider will not be going, as of September 2026. A ride canceled on that call costs no miles and leaves time to fill the slot. The guide to [reducing NEMT no-shows](https://nemtguide.com/guides/how-to-reduce-nemt-no-shows/) has a full routine.
- **Report no-shows instead of dropping riders.** CMS says states may not deny rides because of no-shows, even frequent ones. They may require a rider with a history of no-shows to confirm the ride the night before or the morning of. Report each no-show to the broker the way it asks, so it can act.
- **Build no-shows into the rates you accept.** Because states may build no-show costs into trip rates, work them into the rates you agree to. **No-show cost per completed trip = vehicle and driver cost a month ÷ completed trips a month.** With made-up numbers, $320 over 400 completed trips is $0.80 a trip. See [how to negotiate broker rates](https://nemtguide.com/guides/negotiate-nemt-broker-rates/).
- **Set a private-pay no-show fee.** Outside Medicaid, a no-show fee is a term you agree on in writing with the rider or facility before the ride. Start from the vehicle and driver cost of one no-show, $16 in the example. The [no-show policy template](https://nemtguide.com/templates/nemt-no-show-policy/) and the guide to [private pay NEMT](https://nemtguide.com/guides/private-pay-nemt/) show how.
- **Fill the gap.** Keep a short list of [will-call](https://nemtguide.com/glossary/will-call-trip/) returns and nearby rides that dispatch can move into an empty slot. The guide to [NEMT dispatch](https://nemtguide.com/guides/nemt-dispatch/) covers how to rework the day as it changes.
- **Keep proof of every no-show.** Georgia's broker pays the "A" leg only after an on-time arrival, and MediTrans wants each no-show marked in its portal with a timestamp. A no-show you cannot prove can look like a [missed trip](https://nemtguide.com/glossary/missed-trip/), which counts against you.

## Frequently asked questions

### Do NEMT brokers pay for no-shows?

Usually not. Federal Medicaid funds do not pay for a ride to a member who does not appear, and MTM Health's Missouri provider page says it does not reimburse transportation providers for no-shows, as of September 2026. Georgia is an exception: its NEMT manual (version date July 1, 2026) has the broker pay the "A" leg of the trip when the member fails to board and the provider arrived on time. Check your agreement's rate sheet for a no-show or dry run line.

### Can I charge a Medicaid rider a no-show fee?

No. CMS says states and providers may not impose a charge on a Medicaid member for a no-show (SMD 23-006, September 28, 2023), and a Medicaid provider accepts the program's payment as payment in full under 42 CFR 447.15. Keep no-show fees for private-pay riders and facilities that agreed to them in writing before the ride.

### Should late cancellations go in the no-show count?

Count the ones that came after your driver set out, because they cost the same miles and driver time as a no-show. A cancellation that comes before the van leaves costs no miles, only the open slot, so leave it out. MTM Health's Missouri page answers a cancellation at the door together with no-shows, and pays for neither.

### How long must my driver wait before marking a no-show?

Your state or broker sets it. As of September 2026, Texas Medicaid health plans require at least 10 minutes after the scheduled pickup time, and Georgia's drivers need not wait more than 10. New York requires at least 15 minutes after the scheduled pickup time. MediTrans in Louisiana asks for 15 minutes at a home and 20 at a facility.

### What is a normal NEMT no-show rate?

Track your own, because it changes with your riders and your area. For scale, Wisconsin's statewide NEMT program logged 8,566 member no-shows against 301,246 completed trip legs in May 2026, about 3 for every 100. January to April 2026 ran between 2.9 and 3.0 for every 100.

### Does the drive back after a no-show count in the miles?

Yes. CMS names the driver's return trip after a member does not appear as unloaded miles, which generally cannot be paid. Count the drive out to the pickup and the drive on to the next stop or back to base.

## Official resources

- [CMS: Medicaid Transportation Coverage Guide (no-shows, pages 15 and 29)](https://www.medicaid.gov/federal-policy-guidance/downloads/smd23006.pdf)
- [MTM Health: Missouri transportation provider FAQs](https://www.mtm-inc.net/missouri/transportation-providers/)
- [Georgia DCH: NEMT Policies and Procedures manual (member no-show report, section 1110)](https://www.mmis.georgia.gov/portal/Portals/0/StaticContent/Public/ALL/Handbooks/Non-Emergency%20Medical%20Transportation%20(NEMT)%20Q3%20-%20July%202026%2020260918170713.pdf)
- [Wisconsin DHS: Monthly NEMT data, including member no-shows](https://www.dhs.wisconsin.gov/nemt/reports.htm)
- [eCFR: 29 CFR 785.38, travel time that counts as hours worked](https://www.ecfr.gov/current/title-29/section-785.38)