This article was written by our expert who is surveying the EMS industry and constantly updating the business plan for an emergency medical service (EMS) organization.
This guide explains, in plain English, how much revenue a U.S. EMS organization typically generates per call as of October 2025.
It uses recent benchmarks for reimbursement, costs, payer mix, and operational drivers so you can size revenue accurately and plan viable rates, contracts, and staffing. All numbers are grounded in recognized reports and state datasets.
If you want to dig deeper and learn more, you can download our business plan for an EMS organization. Also, before launching, get all the profit, revenue, and cost breakdowns you need for complete clarity with our EMS financial forecast.
Average reimbursement revenue per EMS transport is close to $1,147, while average fully loaded cost per transport sits around $2,673, creating a structural gap new operators must plan for. Annual call volumes vary from ~1,100 in rural agencies to millions statewide in large systems, driving very different economics.
Revenue per call depends on payer mix (Medicare/Medicaid share), service level (BLS vs. ALS), geography, and non-collection rates. Agencies typically collect 40–60% of what they bill, so disciplined billing, documentation, and contracts are essential.
| Key metric (U.S. EMS) | Typical figure | What this means for a new EMS operator |
|---|---|---|
| Average revenue per call (reimbursed) | ~$1,147 | Expect cash receipts near this level across all payers unless your payer mix or contracts materially differ. |
| Average billed vs. allowed (ALS/BLS) | $1,180–$2,001 billed; $675–$1,133 allowed | Payers allow less than billed charges; build models on allowed/reimbursed amounts, not charges. |
| Collection ratio on charges | ~40–60% | Assume significant write-offs and denials; invest in documentation and revenue cycle workflows. |
| Average cost per transport | ~$2,673 (range ~$1,778–$3,127) | Costs exceed reimbursements on many calls; rely on subsidies, contracts, or efficiency to close the gap. |
| Payer mix reality | Medicare/Medicaid often >50% of runs | Public payers set lower rates; your mix largely determines achievable revenue per call. |
| Annual call volume examples | Statewide CA ~6.7M (2024); small rural ~1.1–1.2k | Scale matters for staffing and unit-hour utilization; small services must manage fixed overhead tightly. |
| Net revenue per call (after write-offs) | Commonly <$1,000 | Target contracts, membership fees, or local funding to stabilize margins. |
What is the average revenue per EMS call in the past year?
The typical reimbursed revenue per EMS transport is about $1,147 across payer types.
This figure reflects allowed amounts actually paid, not list charges, and it already embeds the effect of payer contracts and fee schedules. For planning, treat $1,100–$1,200 per transport as a reasonable national anchor unless your payer mix is unusual.
Because Medicare and Medicaid often dominate run volume, many providers see realized revenue per call cluster near the lower end of private-insurer reimbursements. Document quality, coding accuracy, and medical necessity proofs meaningfully shift realized payment.
It’s a key part of what we outline in the EMS business plan.
Use this revenue anchor only alongside your local payer mix and contractual rates.
How many EMS calls are handled per year?
Annual call volume ranges from ~1,100–1,200 for small rural agencies to millions at the statewide level.
For example, California recorded roughly 6.7 million EMS responses in 2024, with monthly totals around 500,000–600,000. In contrast, a rural service may handle near one thousand calls annually, implying very different staffing and cost absorption.
Higher volumes improve unit-hour utilization and dilute fixed overhead, but also require robust scheduling, fleet availability, and supply chain planning. When volumes spike seasonally, overtime and mutual aid can pressure margins.
You’ll find detailed market insights in our EMS business plan, updated every quarter.
Model both average and peak months for staffing and cash flow.
What is the average billed amount per call by emergency type?
EMS agencies bill higher amounts for ALS than BLS, and emergent trips differ from non-emergent.
The table below shows typical billed vs. allowed benchmarks used by operators when setting expectations and negotiating contracts. Plan around allowed amounts, since that is closer to cash.
| Service category | Typical billed charge | Typical allowed / reimbursed |
|---|---|---|
| BLS – Emergency | ~$1,180 | ~$774 per call; lower than charges due to payer fee schedules |
| ALS – Emergency | ~$1,436 | ~$945 per call; reflects higher clinical intensity |
| BLS – Non-emergent | ~$1,401 | ~$675 per call; frequent non-coverage if medical necessity is weak |
| ALS – Non-emergent | ~$2,001 | ~$1,133 per call; payers scrutinize necessity and origin/destination |
| Mileage add-on (typical) | Varies by payer | Paid per loaded mile; confirm local payer schedules |
| Treat-no-transport | Often billed | Frequently unpaid; check contracts and local programs |
| SCT / specialty care | Higher charge | Allowed varies widely; hospital contracts can improve yield |
What share of billed charges is actually collected?
Most EMS agencies collect about 40–60% of their billed charges.
The gap reflects payer fee schedules, denials for documentation or medical necessity, and write-offs for self-pay accounts. Your realized yield depends on payer mix, documentation discipline, and revenue cycle execution.
Improving ePCR completeness, using modifier codes correctly, and tightening eligibility checks can add 5–10 percentage points to yield in the first year. Dedicated follow-up on secondary insurance and charity-care policies reduces bad debt.
Get expert guidance and actionable steps inside our EMS business plan.
Set KPIs for first-pass acceptance and denial overturn rate.
Who pays for EMS services, and how is revenue distributed?
- Medicare and Medicaid typically account for the largest share of run volume and revenue in many systems.
- Private/commercial insurers usually contribute 30–40% of total payments but pay higher per call than public programs.
- Self-pay/uninsured calls have the lowest collection rates and the highest write-offs.
- Local government funding (levies, subsidies, contracts) often bridges the cost-reimbursement gap.
- Membership programs and hospital/municipal retainers can stabilize cash and reduce dependence on transports alone.
What are typical reimbursement rates by payer?
Payer type drives revenue per call more than list charges do.
Use these payer-specific ranges to model your collections realistically and to set targets for contract negotiations.
| Payer type | Typical reimbursement per call | Notes for operators |
|---|---|---|
| Private insurance | ~$1,147–$1,800 | Often higher than public programs; preauthorization rules apply |
| Medicare | ~$700–$950 | Paid under CMS Ambulance Fee Schedule; zip-code and mile add-ons matter |
| Medicaid | ~$400–$750 | State-specific; frequently below Medicare; enroll in all managed plans |
| Self-pay / uninsured | Under ~$200 realized | Highest non-collection; establish charity policies and payment plans |
| Hospital contracts | Varies by SLA | ED surge, IFT, and standby can be contracted on retainer or per-trip |
| Municipal retainer | Fixed subsidy | Bridges structural reimbursement gap; negotiate CPI adjustments |
| Memberships | $75–$100/household/yr | Offsets deductibles for residents; improves cash predictability |
What are the direct costs per call?
Average fully loaded direct cost per transport centers around $2,673, with wide variation.
Government services often report costs near ~$3,127 per transport, while private-for-profit averages can be closer to ~$1,778, driven by staffing models and overhead allocation.
| Direct cost category | Typical cost per call | Cost driver |
|---|---|---|
| Personnel (crew wages & benefits) | Largest share of total | Unit-hour staffing model, overtime, locality pay |
| Medical supplies & drugs | Moderate | ALS kits, disposable items, controlled meds |
| Vehicle fuel | Variable | Mileage, idling, fuel price swings |
| Vehicle maintenance | Material | Fleet age, duty cycle, vendor pricing |
| Equipment maintenance | Moderate | Monitors, ventilators, stretchers, batteries |
| Communications & CAD | Lower | Radio systems, connectivity, CAD fees |
| Insurance (vehicle & liability) | Non-trivial | Claims history, coverage levels, market rates |
What are the indirect costs per call?
Indirect costs (administration, training, overhead) commonly represent 20–30% of total cost.
Allocation per call depends on call volume, shift coverage, and shared services; low-volume agencies see higher indirect cost per transport.
| Indirect cost category | Allocation method | Operator note |
|---|---|---|
| Administration & billing | % of payroll or per call | Outsourcing can cut fixed payroll but adds vendor fees |
| Training & certifications | Per crew member | Mandatory CE; plan for backfill/overtime during training |
| Facilities & utilities | Sq. ft. or % revenue | Station consolidation and shared bays lower cost |
| IT systems (ePCR, billing) | Per user or per call | Data quality improves reimbursement; budget for interfaces |
| Compliance & QA/QI | Per call | Reduces denials and risk; build checklists and audits |
| Recruitment & HR | Per hire | Turnover raises indirect cost; retention programs pay back |
| General insurance & legal | % of revenue | Claims prevention and risk management lower premiums |
What is net revenue per call after write-offs?
After accounting for denials, uncollected balances, and write-offs, net revenue per call often falls below $1,000.
This is because realized collections rarely exceed 60% of charges and public payer mixes dominate run volume. The result is an average reimbursement near ~$1,147, which is below average cost per transport, creating a structural deficit without subsidies or efficiency gains.
Closing the gap typically requires municipal support, retainers, membership programs, and productivity improvements (better unit-hour utilization and first-pass claim acceptance). Dialing documentation quality directly raises paid revenue.
This is one of the strategies explained in our EMS business plan.
Model sensitivity to 5–10 percentage-point changes in collection rate.
How does revenue per call vary by geography, call type, or service level?
Revenue per call varies widely across urban vs. rural settings and by BLS vs. ALS service level.
Use these ranges to benchmark your local results and to prioritize the contracts that move your average up.
| Segment | Typical revenue per call | Why it differs |
|---|---|---|
| Urban ALS (municipal) | $1,500–$2,500+ | Higher acuity, negotiated retainers, better payer mix |
| Urban BLS | $900–$1,400 | Lower intensity and lower add-ons than ALS |
| Rural ALS | $800–$1,300 | Longer miles but weaker payer mix and higher non-collection |
| Rural BLS | ~$700–$1,000 | Lower allowed amounts and volume; overhead burden higher |
| Non-emergent IFT | $650–$1,150 | Scrutiny on medical necessity; contract rates matter |
| SCT / specialty | $1,200–$2,000 | Advanced care billing and equipment justifies higher payment |
| Treat-no-transport | $0–$300 | Often unpaid; local programs may reimburse limited services |
What trends or seasonality affect revenue per call?
- Winter spikes in respiratory and cardiac cases raise call volume and total receipts.
- Population aging and chronic disease prevalence push steady growth in EMS demand.
- Traffic exposure and special events create episodic surges requiring overtime coverage.
- Payer policy changes (e.g., documentation rules) impact denial rates and cash timing.
- Fuel and wage inflation raise costs faster than fee schedule updates, squeezing margins.
What benchmarks can I use to compare performance?
Use national averages to sanity-check your collections and costs.
Compare your realized revenue per call to ~$1,147 and your cost per transport to ~$2,673, then analyze variance by payer mix, denial rate, and unit-hour utilization. State reports and chartbooks provide additional local context.
Track KPIs monthly: collection rate on charges, days in A/R, first-pass acceptance, denial overturn, and cost per unit hour. Establish action thresholds to trigger billing audits or staffing changes.
| Benchmark | Target / reference | Interpretation |
|---|---|---|
| Revenue per call (all payers) | ~$1,147 | Below this? Check payer mix and documentation quality |
| Cost per transport | ~$2,673 | Persistent gap implies need for subsidies or efficiency |
| Collection % of charges | 40–60% | Low figures flag denials, coding, or self-pay exposure |
| First-pass claim acceptance | ≥85% | Lower rates increase A/R days and write-offs |
| Days in A/R | 30–60 | Long tails indicate follow-up problems and cash drag |
| ALS vs. BLS mix | Local pattern | Higher ALS share raises average allowed amount |
| Public payer share | Often >50% | Higher share lowers average payment per call |
What percentage of billed charges is collected from patients and insurers?
Expect to collect roughly 40–60% of billed charges across your payer mix.
Collections cluster toward the lower end when Medicaid share is high or documentation is weak; robust QA/QI and billing workflows push results upward. Secondary insurance capture and faster eligibility checks raise payments without changing call volume.
Design KPIs for denial categories and institute weekly claim audits; these actions reduce write-offs materially. High self-pay exposure requires early outreach and payment plans to avoid bad debt.
We cover this exact topic in the EMS business plan.
Always budget conservatively on collections in year one.
What is the total number of EMS calls nationally each year?
Total U.S. EMS calls number in the many millions annually.
California alone reported about 6.7 million responses in 2024, and other states show similar scale relative to population. Small agencies commonly see ~1,100–1,200 runs per year, which shapes staffing and unit deployment.
Plan capacity for peak months and tourist/event surges if relevant in your geography. Coordination with hospitals and PSAPs improves turnaround times and throughput on busy days.
This is one of the many elements we break down in the EMS business plan.
Use rolling 12-month totals to trigger staffing changes.
What is the average reimbursement gap versus cost?
The average reimbursement (~$1,147) falls about ~$1,526 short of the average cost (~$2,673) per transport.
This negative spread explains why many EMS systems rely on municipal subsidies, retainers, or cross-subsidy from other services. Closing the gap depends on payer contracting, fleet productivity, and meticulous billing.
Include mileage and rural/zip-code add-ons where applicable to lift revenue per call. On costs, focus on overtime containment and preventive maintenance to protect margins.
This is one of the strategies explained in our EMS business plan.
Review rates annually and align with CPI and cost trends.
Conclusion
This article is for informational purposes only and should not be considered financial advice. Readers are encouraged to consult with a qualified professional before making any investment decisions. We accept no liability for any actions taken based on the information provided.
Want more EMS insights?
Explore detailed guides on startup costs, profitability, revenue levers, and market size to refine your EMS financial model.
Sources
- EMS1 – Quantifying the gap between expenses and revenue for EMS services
- California EMSA – 2024 Annual EMS Data Report
- MASA – Emergency Medical Transport Costs 2024 (Whitepaper)
- Rhode Island Center for EMS – 2024 Annual Report
- WA OIC – Ground Ambulance Balance Billing Report
- Massachusetts – Ambulance Utilization & Payment Rates Chartpack
- CMS – Ambulance Fee Schedule (Public Use Files)
- CMS – Ground Ambulance Data Collection System (GADCS)
- King County EMS – 2024 Annual Report
-EMS Startup Costs: What to Budget
-Is an EMS Organization Profitable?
-EMS Budget Template: Build Your Numbers
-EMS Revenue Model: How to Increase Collections
-EMS Profit Margin: What to Expect
-EMS Market Size: 2025 Outlook
-Ambulance Services: Key Industry Trends
-When Is an Ambulance Service Profitable?