NEMT Service Level Assessment Guide
A reference guide for healthcare assessors, discharge planners, and case managers to select the correct transport level for each patient. Includes a decision tree, comparison table, service level definitions, and documentation requirements.
Dream Care Rides — Service Level Assessment Guide
For Healthcare Assessors • (708) 505-6994 • NPI #1033989991
Assessment Decision Tree
Use this flowchart to determine the appropriate transport level. Start at the top and follow the path that matches your patient's current mobility status.
Patient walks to/from vehicle
Ramp/lift access
Patient must lie flat
Special case: If the patient weighs 300+ lbs with mobility limitations → Bariatric Transport (specialty vehicle with wide ramp — call (708) 505-6994 for availability)
Service Level Comparison
| Feature | Ambulatory | Wheelchair | Stretcher | Bariatric |
|---|---|---|---|---|
| Vehicle | Sedan/SUV | ADA Van | Ambulette | Specialty Van |
| Patient Mobility | Walks independently or with cane/walker | Uses wheelchair, can transfer with help | Cannot sit upright, must remain supine | 300+ lbs with limited mobility |
| Assistance | Walk-on support | Ramp or hydraulic lift | Gurney with 2 attendants | Wide ramp, reinforced equipment |
| Service Levels | Curb-to-Curb, Door-to-Door, Hand-to-Hand | Curb-to-Curb, Door-to-Door, Door-Through-Door | Room-to-Room, Door-Through-Door, Bed-to-Bed | Custom (call for details) |
| Starting Base (per leg) | $50–$60 | $60–$70 | $350–$400 | Call for quote |
| Per Mile | $3.00/mi after the first 3 miles | $3.50/mi after the first 3 miles | $6.00/mi after the first 5 miles | Call for quote |
Base rates are per one-way leg; a round trip is two legs. Flat surcharges: weekends +$50 per leg, after-hours pickups +$50–$300 per leg, wait time $15/15 min (first 15 min free), oxygen +$25, stair chair +$40; major holidays add a fee shown before you book.
Service Level Definitions
Curb-to-Curb
Driver picks up the patient at the curb of the pickup address and drops them off at the curb of the destination. Patient is responsible for getting to and from the vehicle.
Available for: Ambulatory, Wheelchair
Door-to-Door
Driver assists the patient from the exterior door of the pickup location to the vehicle, and from the vehicle to the exterior door of the destination.
Available for: Ambulatory, Wheelchair
Door-Through-Door
Driver assists the patient from inside the pickup location (lobby, room, or residence) through the destination building to the check-in desk or waiting area.
Available for: Wheelchair, Stretcher
Hand-to-Hand
Driver stays with the patient from pickup to hand-off at the destination. The patient is physically accompanied from one person's care to another (e.g., caregiver to nurse).
Available for: Ambulatory
Room-to-Room
Two attendants transport the patient on a gurney from one room (hospital room, nursing home room) to a room at the destination facility.
Available for: Stretcher
Bed-to-Bed
Full transfer assistance. Patient is moved from their bed at the origin to a bed at the destination, including all lifting and positioning by trained attendants.
Available for: Stretcher
When to Upgrade Service Level
The following clinical indicators suggest the patient requires a higher service level than their baseline mobility might indicate. When in doubt, err on the side of a higher service level. Call (708) 505-6994 if you need guidance.
Ambulatory → Wheelchair
- • Patient becomes fatigued after walking short distances (less than 50 feet)
- • Recent fall history within the past 30 days
- • Post-surgical with weight-bearing restrictions
- • Severe balance issues, vertigo, or dizziness
- • Oxygen-dependent and unable to carry portable unit while walking
- • Cognitive impairment that creates elopement risk during building navigation
Wheelchair → Stretcher
- • Patient cannot maintain a seated position for the duration of the trip
- • Spinal precautions or immobilization required
- • Post-surgical with restrictions on sitting upright
- • Severe pain that prevents seated position
- • IV lines, drains, or medical devices that require supine positioning
- • Contractures preventing safe wheelchair seating
Documentation Requirements
| Service Level | Private Pay | Medicaid |
|---|---|---|
| Ambulatory | No documentation required | MCO authorization (varies by plan) |
| Wheelchair | No documentation required | MCO authorization + mobility assessment on file |
| Stretcher | Physician order recommended | MCO authorization + Physician Certification Statement (PCS) |
| Bariatric | Patient weight disclosure at booking | MCO authorization + weight documentation + PCS if stretcher |
Frequently Asked Questions for Assessors
How do I determine if a patient needs wheelchair or stretcher transport?
If the patient can sit upright in a wheelchair and transfer with assistance, wheelchair transport is appropriate. If the patient cannot maintain a seated position, must remain supine, or requires continuous monitoring during transport, stretcher transport is required. Call (708) 505-6994 if you are unsure.
What documentation is needed for stretcher transport?
Stretcher transport typically requires a physician order or medical necessity form stating the patient cannot sit upright for the duration of transport. For Medicaid-covered stretcher trips, the MCO may require a Physician Certification Statement (PCS) confirming medical necessity.
Can a patient be upgraded from ambulatory to wheelchair mid-trip?
Service level changes cannot be made mid-trip because different vehicle types are required. If a patient’s condition changes, call (708) 505-6994 to schedule a new trip at the correct service level. Always assess the patient at the time of scheduling.
What is the difference between door-to-door and door-through-door?
Door-to-door means the driver walks the patient from the exterior door of pickup to the exterior door of the destination. Door-through-door means the driver assists the patient inside the building to the reception area or exam room. Choose door-through-door for patients who need help navigating inside facilities.
Does Dream Care Rides handle bariatric patients?
Yes. Dream Care Rides provides bariatric transport for patients weighing 300+ pounds with mobility limitations. Bariatric transport uses specialty vehicles with wide ramps and reinforced equipment. Call (708) 505-6994 for availability and pricing.
Who should I call if I am unsure which service level to select?
Call Dream Care Rides dispatch at (708) 505-6994. Describe the patient’s mobility, medical condition, and equipment needs. Our team will help you determine the appropriate service level.
Questions about service level selection? Call Dream Care Rides dispatch:
Dream Care Rides • 20000 Governors Dr Suite 103H, Olympia Fields, IL 60461 • NPI #1033989991
Need Help Assessing a Patient?
Our dispatch team can help you determine the right service level over the phone. Call us with the patient's mobility details and we will recommend the appropriate transport.