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Ambulance Billing

No one should ever hesitate to call 911 because of inability to pay or lack of insurance. Clarke County’s top priority is providing the best possible emergency medical care.

In May 2015, Clarke County Board of Supervisors, Clarke County Fire, EMS & Emergency Management, and the Clarke County Volunteer Fire and Rescue Association established a billing system for EMS transports known as Fee for Service. The majority of localities across the United States have a Fee for Service, charging medical insurance carriers for ambulance transport services.

Ambulance Fee Base Rates

  • Basic Life Support (BLS) Transport Emergency: $440
  • Basic Life Support (BLS) Transport Non-Emergency: $431
  • Advanced Life Support (ALS) Transport Non-Emergency: $512
  • Advanced Life Support (ALS) Transport Emergency: $550
  • Advanced Life Support, Level 2 (ALS) Transport: $755
  • Mileage per loaded mile from pickup location to hospital: $11
  • Treated-Not-Transported (flat rate): $150

Whether transporting a patient or not, emergency medical technicians (EMTs) follow the same procedures. The EMT completes the report as required by state and federal regulations and follows local protocols.

The Fee for Service program that went into effect in July 2018 allows the county-wide system to bill for calls designated as Treatment Not Transported (TNT) and any portion of a bill not covered by the patient's insurance company. The patient (or the person legally responsible for the patient) will be liable for payment of any remaining deductible, co-payments or plan limits not covered by the health insurance provider.

Treated Not Transported (TNT) means two or more procedures and/or treatments are provided to a patient, and the patient chooses not to be transported via ambulance to the hospital. There is a flat fee of $150 for TNT service. Some examples of two or more treatments and/or procedures include vitals and bandage, medication and vitals, or IV and medication. A single procedure or treatment such as bandaging does not qualify under this category. Helping a patient who has fallen out of bed – lifting him/her up and placing back into bed – does not qualify as any type of treatment or procedure.

If a patient refuses transport to the hospital but receives two or more treatments and/or procedures, the EMT is required to scan the patient’s insurance card and/or driver’s license. The EMT will also obtain a signed consent of refusal.

All services are billed to the patient’s insurance company first. Then – if applicable – patient balances such as co-payments, deductibles, and plan limits are billed to the patient.

The TNT fee does not apply if a patient decides to be transported to the hospital. If transported, patient will be billed according to the level of service provided and the mileage from point of pickup to the hospital. If insurance information is not available at the time of service, Clarke County’s billing company will send a letter to the patient asking for insurance information. Once received, the insurance provider will be billed.

Clarke County’s third-party billing company is Premier Accounts Receivable Management. Send check (payable to Clarke County Fire & EMS) to Premier Accounts Receivable Management, P.O. Box 1910, Winchester VA 22604. Pay with credit card via Official Payments using Jurisdictional Code 1043.

Payment Options

  • Uninsured discount: 25% discount for accounts paid in full within 30 days from statement date.
  • Monthly payment plan: Clarke County will work with you to establish an agreed upon payment schedule.
  • Hardship assistance: If eligible, fees can be adjusted or waived. Note: Hardship standard is based on federal poverty guidelines annually published by the U.S. Department of Health and Human Services.

U.S. Department of Health & Human Services 2020 Poverty Guidelines (effective Jan. 15, 2020):

  • 1 person in household: $12,760
  • 2 persons in household: $17,240
  • 3 persons in household: $21,720
  • 4 persons in household: $26,200
  • 5 persons in household: $30,680
  • 6 persons in household: $35,160
  • 7 persons in household: $39,640
  • 8 persons in household: $44,120
  • More than 8 persons in household, add $4,480 for each additional person.


Contact Billing Coordinator Melanie Radford at (540) 955-5105 or Fax number is (540) 955-5180.

Additional Information