NEMT Rate Sheet Template – Non-Emergency Medical Transportation Pricing & Mileage Fee Sheet

Present your transportation rates clearly and professionally with this customizable NEMT Rate Sheet Template, designed specifically for Non-Emergency Medical Transportation (NEMT) companies.
This printable and editable pricing sheet makes it easy to organize and communicate your rates for ambulatory, wheelchair, and stretcher transportation, along with mileage charges, wait-time fees, after-hours pricing, weekend surcharges, and round-trip discounts.

Perfect for NEMT business owners, medical transportation providers, dispatch teams, billing departments, healthcare facilities, case managers, and contract proposals, this template gives your business a professional rate sheet that can be customized with your own pricing.

WHAT’S INCLUDED
This NEMT Rate Sheet Template includes sections for:
• Ambulatory Transportation Rates
• Wheelchair Transportation Rates
• Stretcher Transportation Rates
• Base / Pickup Rates
• Per-Mile Charges
• Wait-Time Fees
• After-Hours Surcharges
• Weekend Surcharges
• Round-Trip Discounts
• Additional Fees
• Pricing Notes
• Service Terms
• Company Information

The template includes dedicated pricing areas for ambulatory, wheelchair, and stretcher transportation and allows businesses to establish separate base rates and per-mile charges for their services.

PERFECT FOR
• NEMT Companies
• Non-Emergency Medical Transportation Providers
• Medical Transportation Businesses
• NEMT Startups
• Patient Transportation Companies
• Wheelchair Transportation Services
• Ambulatory Transportation Providers
• Stretcher Transportation Services
• NEMT Fleet Operators
• Dispatch Coordinators
• Billing Teams
• Transportation Contractors
CREATE A PROFESSIONAL NEMT PRICING SHEET
Give prospective clients, healthcare facilities, and business partners an easy-to-understand breakdown of your transportation rates.
Use this template to help:

✓ Establish base transportation rates
✓ Document per-mile pricing
✓ Set separate ambulatory rates
✓ Establish wheelchair transportation pricing
✓ Document stretcher transportation rates
✓ Establish wait-time fees
✓ Add after-hours and weekend surcharges
✓ Offer round-trip discounts
✓ Communicate additional fees
✓ Present your pricing professionally
✓ Maintain consistent quotes across your business

AMBULATORY, WHEELCHAIR & STRETCHER RATES
Different transportation services may require different pricing structures.
This template provides separate pricing areas for:

Ambulatory Transportation
Document rates for passengers who can enter and exit the vehicle with minimal or no mobility assistance.

Wheelchair Transportation
Establish separate pricing for wheelchair-accessible transportation services.

Stretcher Transportation
Document applicable rates for stretcher transportation when your company is appropriately equipped and authorized to provide the service.

The original template specifically includes separate pricing for all three transportation categories.

BASE RATE & PER-MILE PRICING
Create a flexible pricing structure by combining a base transportation rate with a per-mile charge.
Customize the rate sheet with your:

• Base / Pickup Fee
• Loaded Mileage Rate
• Per-Mile Charge
• Minimum Trip Charge
• Wait-Time Fee
• Additional Stop Fee
• After-Hours Fee
• Weekend Fee
• Other Applicable Charges

Only include fees and services that your company actually provides.

WAIT TIME, AFTER-HOURS & WEEKEND FEES
Account for transportation services that require additional driver time or scheduling outside your normal business hours.
The template includes areas for wait-time fees and after-hours/weekend surcharges, allowing you to customize these charges based on your company's actual pricing structure.

ROUND-TRIP DISCOUNT
Want to encourage clients and facilities to schedule both legs of a trip with your company?
The template includes a dedicated round-trip discount field, giving you the option to establish special pricing for qualifying round-trip transportation.

GREAT FOR FACILITY CONTRACTS & NEMT PROPOSALS
This rate sheet isn't limited to individual customers. It can also be used when communicating pricing to:
• Hospitals
• Nursing Facilities
• Assisted Living Facilities
• Rehabilitation Centers
• Dialysis Centers
• Medical Offices
• Case Managers
• Social Service Organizations
• Transportation Brokers
• Private-Pay Clients

The existing listing specifically identifies facility RFPs, case managers, clients, and contract proposal submissions as potential uses for the rate sheet.

CUSTOMIZABLE FOR YOUR NEMT BUSINESS
Personalize the template with your:
• NEMT company name
• Business logo
• Contact information
• Service types
• Base transportation rates
• Mileage rates
• Wait-time charges
• After-hours fees
• Weekend fees
• Round-trip discounts
• Additional charges
• Pricing terms

DIGITAL DOWNLOAD
This is a digital product. No physical item will be shipped.
Your purchase includes PDF and Word document formats, allowing you to customize your company's pricing and print or electronically share the completed rate sheet.

After purchase, download the files, enter your NEMT company's rates and information, and use the completed sheet when providing quotes or communicating pricing to clients and facilities.

IMPORTANT DISCLAIMER
This template is provided for general informational and business-documentation purposes only and does not constitute legal, financial, Medicaid, Medicare, insurance, transportation, billing, or regulatory advice.
NEMT rates and billing requirements may vary depending on your location, payer, transportation broker, facility contract, vehicle type, passenger needs, and services provided.

Private-pay rates established by your company may differ from reimbursement rates established by Medicaid programs, transportation brokers, managed care organizations, insurers, or contracted facilities.

Businesses are responsible for establishing appropriate rates and ensuring their pricing, billing, transportation services, and disclosures comply with applicable contracts and requirements.

Due to the nature of digital products, all sales are final.