08/02/2026
Ambulance Reimbursements
As we continue discussing rural EMS coverage in Pennington County, one important issue is ambulance reimbursement.
Ambulance services are generally reimbursed for transports, not simply for being ready to respond. That means EMS can staff a crew, maintain an ambulance, respond to a 911 call, and tie up personnel, but if there is no transport, reimbursement may be limited or nonexistent.
South Dakota Medicaid ambulance rates include:
BLS Non-Emergent: $280.09
BLS Emergent: $448.15
ALS Non-Emergent: $336.11
ALS Emergent: $532.18
ALS Level 2: $770.25
Specialty Care Transport: $910.30
Loaded ground mileage: $9.00 per mile
When compared to surrounding states, South Dakota’s Medicaid rates appear to be higher than Montana and Wyoming, close to Minnesota, and lower than North Dakota.
The larger issue is that Medicaid, Medicare, private insurance, VA, IHS, and patient payments all help, but they generally do not cover the full cost of keeping ambulances staffed, equipped, and ready — especially in rural areas with long distances, lower call volume, and more non-transport responses.
EMS billing helps pay for transports. It does not fully pay for readiness.
