User Fee Structure

Fee Structure

Wake County EMS ambulance User Fees (patient billing) are in place for the purpose of recouping costs. User Fees are set by the County Commissioners, based on established Medicare rates. Even though current rates are set at 150% of the Medicare rates, the user fees still do not recoup all costs. 

EMS ambulance billing is determined by the service provided. The following terms are used to describe service types. 

  • Basic Life Support (BLS) – Medical evaluation, vital signs, bandaging, splinting, oxygen, etc. 
  • Advanced Life Support (ALS) – Medications, IVs, advanced airway procedures, heart monitoring, 12-lead EKGs, heart pacing, etc.  
  • ALS I – ALS procedure 
  • ALS II – Multiple ALS procedures 
  • Loaded Miles – Distance of transport with patient on board 

Everyone transported to an Emergency Department (ED) receives at least BLS care. Some patients receive ALS I or ALS II care. 

Not all patients we see are transported to an ED. Some patients who are not transported may still receive BLS, ALS I, or ALS II level care. There may be a BLS No Transport fee charged when medical supplies are used. There may be an ALS No Transport fee charged when ALS procedures are performed. ALS No Transport is a single rate, regardless of whether multiple ALS procedures are performed. 

Per Medicare standards, Wake County EMS does not itemize bills, but instead uses the Medicare flat rate structure.  Rates below are effective January 1, 2020. 

BLS​​ Fee: $540.06 ​+ ​$11.43/loaded mile

​ALS I​ Fee: $641.33 ​+ $11.43/loaded mile

ALS II Fee: ​$928.23 ​+ ​$11.43/loaded mile

BLS No Transport Fee: $150

ALS No Transport Fee: $200

Average Out-of-Pocket Costs

In some situations insurance companies and Medicare pay some portion of the EMS bill. What remains of the bill after they have paid is the responsibility of the patient. Refer to your insurance company or Medicare for information on how much they will cover. 

Below are average out-of-pocket costs for which a patient is responsible, based on who the primary payor is. These figures average all levels and types of service and do not account for multiple payors. This chart is not intended to predict your bill, but rather to show averages of all patients' costs. Your bill may vary significantly from the averages seen here. 

Average Costs Based on Primary Payor
Insurance: $184
Medicare: $91
Self Pay: $367
Medicaid: $0