Data & Methodology

Transportation services: Ground — BLS, ALS-1, ALS-2, SCT, and paramedic intercept (A0428, A0429, A0426, A0427, A0433, A0434, A0432); Air — fixed wing and rotary wing (A0430, A0431); and mileage (A0425, A0435, A0436).

Payers: Original Medicare Part B fee-schedule benchmarks. Medicaid, commercial, and self-pay amounts are your assumptions (see Contract Pricing).

Geographic areas: All 50 states, D.C., and U.S. territories served by Medicare Administrative Contractor (MAC) localities.

Years: Calendar Year 2026 Medicare Ambulance Fee Schedule. The national base-rate conversion factor for CY 2026 is $284.56, adjusted by each locality's GPCI and RVUs.

Each dataset is named with its publishing organization and a direct link where available.

Hospital information is resolved through web search and is confidence-rated. It is not a confirmed, licensed facility dataset — verify the resolved ZIP before relying on it for billing.

Effective period: CY 2026 (January 1 – December 31, 2026).

Source release: CMS CY 2026 Ambulance Fee Schedule.

Import date: Rate data is loaded for the current calendar-year release; the in-app rate note shows the active calendar year.

Last validation: Reviewed against published CMS fee-schedule materials at each calendar-year update.

CMS news feed: Refreshed approximately every 20 hours through web search — not real-time. Publication and effective dates are shown separately, and proposed rules are distinguished from final rules.

We do not claim "real-time" or "always current" data. The fee schedule is updated with each calendar-year release.

Rate lookup: A ZIP code is matched to a Medicare locality and rural designation through the CMS ZIP/Carrier/Locality crosswalk. The applicable fee-schedule amount is selected by designation: Urban = urban rate; Rural = rural rate; Super-Rural (lowest quartile) = super-rural rate. Rural designation comes from the CMS crosswalk — it is never inferred from a city name.

Mileage: Addresses are geocoded with the U.S. Census Geocoder, then driving distance and time are computed with OpenRouteService. If routing fails, a straight-line distance × 1.3 road factor at ~35 mph is used and the result is labeled "estimated." Loaded miles are the sending-to-receiving leg; all other legs are deadhead (operating cost, not Medicare-reimbursable).

Revenue estimator: (applicable base rate + loaded mileage cost) × trips, annualized × 12. A custom-rate column applies your entered percentage to the Medicare benchmark: benchmark × (1 + entered %).

Contract pricing: The per-transport Medicare Fee Schedule Amount (base + loaded mileage) is multiplied by each payer's rate percentage and weighted by payer mix, then summed. Payer rates are your assumptions.

Service-area comparison: Applicable rates are computed per ZIP and averaged by designation. ZIPs are sorted by the BLS Non-Emergency Medicare Fee Schedule amount. You provide the ZIP list — the tool does not select ZIPs by radius.

• Medicaid, commercial, and self-pay rates are user assumptions, not imported state or payer schedules.
• Hospital information is web-search-sourced and confidence-rated; verify before relying on it.
• Mileage is driving distance when available; the fallback is an estimate.
• Results are reimbursement benchmarks, not guaranteed payments. Actual payment depends on eligibility, medical necessity, claim processing, and payer rules.
• The service-area report ranks ZIPs by Medicare rate only. It does not measure "market opportunity" (which would require demand, costs, and payer mix) and does not identify "coverage gaps" (which would require a defined coverage standard and adequate data).

Use the Report a Data Issue button on any report to flag a rate, location, classification, calculation, or source-link problem. You receive a confirmation number, and we respond to the email you provide when a correction is made.

Material data or calculation corrections are logged below with the date and what changed.

To report an issue now, use the Report a Data Issue button on any report, or contact us.