Cost and Utilization of Ambulance Services Across the United States

Introduction: The costs associated with ambulance services are varied and poorly understood, which may contribute to financial burden and barriers to care for patients. Methods: We describe differences in ambulance service costs, comparing public versus private companies, by using the Centers for Medicare and Medicaid Services public use files. We determined the two largest public and two largest private ambulance companies in each state and calculated the average miles traveled per ambulance ride, number of trips by company, adjusted cost, and CPT code usage. We compared these variables between 2019 and 2021, across nine geographic divisions of the US. Results: In both 2019 and 2021, the average costs (adjusted for total service) of public companies were higher than the average costs of private companies. In both years, public companies had fewer average miles traveled compared to private companies. The distribution of CPT codes used was significantly different in public and private companies. The CPT code used most frequently by public companies was more expensive than the CPT code used most often by private companies. Conclusions: Differences in ambulance billing practices may contribute to financial uncertainty for patients. This study underscores the need for further investigation into the factors driving these disparities to inform policy decisions and improve cost transparency for patients.