The Ambulance Fee Schedule Runs on 1998 Costs. A New Bill Wants to Fix That.
The bipartisan RESCUE Act would force CMS to rebuild the Medicare ambulance fee schedule every three years on current cost data — ending a formula frozen since 2002. It's the right fight. It's also a reminder that cost data and clean billing are the levers you control now.
Here is a fact that should be more scandalous than it is: the formula Medicare uses to pay for ambulance transports has not been meaningfully rebuilt since 2002, and the cost data underneath it dates to the late 1990s. Every agency in the country is being reimbursed against a picture of what it cost to run an ambulance during the Clinton administration.
That may be about to change. This week, Representatives Brad Schneider and August Pfluger introduced the bipartisan RESCUE Act (https:/ / schneider.house.gov/ media/ press- releases/ schneider- pfluger- introduce- bipartisan- rescue- act- ensure- fair- ambulance), which would require CMS
to update the Medicare ambulance fee schedule every three years based on current cost data. In plain terms: the bill would force the payment formula to keep up with reality on a regular schedule, rather than drifting a quarter-century out of date and waiting for Congress to notice.
Why a frozen formula is the root of the readiness problem
EMS leaders talk constantly about the gap between what a transport pays and what it costs to be ready. The frozen fee schedule is a direct cause of that gap. Wages, fuel, vehicles, medical supplies, and insurance have all climbed for two decades. The benchmark those costs are measured against has not. When the input is stale, the output — your reimbursement — is structurally too low, and it gets more too-low every year the freeze continues.
A triennial rebuild wouldn't guarantee generous rates. But it would tie payment to current cost reality on a predictable cadence, which is exactly the connection that's been missing. That's why the bill matters beyond any single year's dollar figure: it changes the mechanism, not just the number.
The catch hiding in "based on current cost data"
Read the bill's premise closely and you find the theme that keeps recurring in EMS payment policy: everything depends on cost data. A fee schedule rebuilt on current costs is only as good as the cost data feeding it. If agencies can't produce clean, credible numbers on what it actually costs to keep a licensed crew and a stocked truck available around the clock, even a well-intentioned formula has nothing solid to stand on.
That's the quiet obligation inside a bill like this. Better payment policy and better agency data collection are not separate projects. The same discipline that lets you prove your costs to CMS is the discipline that runs a healthy revenue cycle: accurate capture at the point of care, organized documentation, and numbers you can defend. Agencies that treat cost reporting as a nuisance will be underrepresented in exactly the data that sets their future rates.
What to do while the bill moves
The RESCUE Act deserves the industry's support, and EMS leaders should say so — to their representatives, their state associations, and their networks. Advocacy is how the mechanism actually gets fixed. But legislation moves in years, and there is a version of every payment-reform cycle where agencies wait for Washington and neglect the margin sitting in their own operations. Don't. Two things are true at the same time:
• The fee schedule is too low, and fixing it is largely out of your hands. Support the bill; keep the pressure on.
• Most agencies are not collecting everything the current — even inadequate — schedule already owes them. That part is entirely in your hands, and it's recoverable this quarter, not this decade.
Clean claims filed correctly the first time, denials worked before they age out, transports billed at the right rate, and cost data captured well enough to strengthen the industry's case — none of that requires a single vote. It's the margin you can protect while the slower fight plays out.
The throughline
The RESCUE Act is a genuinely good development because it attacks the root of the payment problem: a formula disconnected from cost reality. Back it. But the same insight that makes the bill smart — that everything runs on current, credible cost data — is the insight that should reshape how your agency runs today. Fix what you control, produce the data that wins the bigger argument, and you'll be ready to benefit the moment the policy catches up.
Built by EMS, for EMS.