What Is a Gurney? Stretcher NEMT Costs, Rules, Margins

Updated October 2026: stretcher rates refreshed and sources added.

Depending on the state, a stretcher trip pays anywhere from a few dollars more than the same wheelchair trip to five times as much. It also requires two crew members instead of one, a cot and fastener that list from about $3,100 to well over $10,000, and, in some states, a license you probably do not have. Get the classification wrong and the consequence is not a paperwork fine: in Arizona, the state can find you were operating an unregistered ambulance.

Here is what a gurney is, what the equipment costs, where the legal line sits between stretcher NEMT and ambulance service, and whether the margin justifies it.

Gurney vs stretcher: is there a difference?

In US non-emergency medical transportation, "gurney" and "stretcher" mean the same thing. The split is colloquial: "gurney" is common in consumer marketing (and in California's litter van rules), "cot" is what EMS crews and equipment makers say, "stretcher" is what most state regulations and Medicaid fee schedules say. As one private-pay provider puts it: "In the NEMT industry, the terms gurney, stretcher, and cot are used interchangeably." No hidden technical distinction changes your billing, license or insurance, and anyone selling you a hard definitional difference is padding a blog post.

Where the terms do diverge is equipment class, and that distinction is real and expensive:

• EMS cot (ambulance cot). The roll-in, multi-level unit that locks into a floor-mounted fastener. This is what a gurney van carries; Ferno and Stryker are the names you will see most in listings.
• Transport stretcher. In-facility equipment, the flat, high-side units that move a patient from a room to radiology. Some carry high weight ratings, but they are not crash-secured and do not mate to a road fastener. Do not buy one because the capacity number looked good.
• Bariatric cot. A wider, reinforced roll-in cot with a stepped weight rating (higher capacity at lower height positions), different fastener geometry, lift plan and crew count.
• Stair chair. Not a stretcher, but stretcher service is hard to run without one. Second-floor walk-ups and narrow hallways are where cot service fails.

What determines whether a unit works is cot class, weight capacity, and how it secures to the floor. Everything else is nomenclature.

The name your state uses is the one that matters

Regulators do not care what you call it either. California regulates "litter vans." Arizona, Illinois and Oklahoma regulate "stretcher vans." New York pays a category called "Stretcher Ambulette." Ohio's statute defines an ambulette around people "who require use of a wheelchair or other mobility aid," a deliberate piece of drafting. Find your state's term before you find your cot.

The equipment stack and what it costs

Prices below are public listings checked October 1, 2026: reference points, not quotes. Certified refurbished cots are widely listed at a fraction of the new price.

The fastener is the line item first-time buyers under-budget. Stryker's 6370/6371 cot fasteners are Ferno's equivalent. The antler engages the cot head, the rail and floor plates take the load, and that hardware bolts into structural floor, not a plywood deck over sheet metal. California requires fasteners that hold the gurney and patient if the vehicle overturns; New York requires the retention device to come from the cot's manufacturer. A powered cot costs several times a refurbished manual one in these listings; the case for it is not comfort but taking the lift out of the highest-risk motion in the job.

The vehicle: what a gurney van has that a wheelchair van doesn't

California's litter van rule is the most concrete published spec sheet we have found and a reasonable build checklist anywhere. It requires a loading entrance "large enough to accommodate a patient comfortably lying on a standard-sized gurney," an emergency exit that also accommodates a gurney, door latches operable from inside and outside, interior and portable lighting, heating and air conditioning, a 4-B:C fire extinguisher, business identification, and "one two-man gurney with mattress and upper and lower restraining straps."

In practice: a mid- or high-roof full-size van, Transit, ProMaster, Express, Sprinter, with interior height for an attendant to work beside a raised cot, a reinforced floor for the fastener, an attendant seat with its own belt, and a load method (lift, winch-assisted ramp, or manual lift onto a loading wheel). Minivan cot conversions exist, but the capability envelope is far narrower.

Pricing is the least transparent corner of the NEMT vehicle market; most builders quote by phone. National Fleet Sales lists a 2026 Ford Transit 350 148" mid-roof gurney van with a 34" side-entry lift from $79,900 plus tax, registration and delivery ($78,900 for the rear-lift wheelchair version), without saying whether a cot is included. Avan Mobility publishes $145,000 to $225,000 for its mobile response van, including conversion and medical equipment: a ceiling, not a benchmark. Plan on the full-size lift van price plus cot, fastener install, attendant seat and interior work. For the underlying vehicle math, see our breakdown of NEMT startup costs and licensing.

The regulatory line, the part that ends businesses

Every state rule we reviewed that permits stretcher NEMT draws the same boundary in different words: no medical care en route. The moment your crew monitors, treats or intervenes, you are providing ambulance service. There are three regimes, and you need to know which one you are in before you spend a dollar.

Regime 1: an explicit stretcher van license. Illinois licenses stretcher van providers under the Department of Public Health's EMS code, and its operating rule is unusually specific: "No stretcher van may be operated with a crew of fewer than two trained attendants. One trained attendant shall remain with the passenger." Attendants must be CPR-certified and trained on the cot. The rule bars transporting anyone needing monitoring, non-self-administered oxygen, airway management, suctioning or IV fluids, and lists riders whose condition prevents cooperation as inappropriate; dementia and elopement risk are named. Oklahoma runs a separate Stretcher Van Service license: a $600 initial application fee, $20 per van beyond two, and $150 per substation, a two-person crew with a certified Emergency Medical Responder attendant, and an equipment list including an AED, secured oxygen cylinders and an elevating gurney whose locking equipment meets the AMD 004 standard. Your service area must be an EMS region, an ambulance district, or a county of more than 500,000 people.

Arizona's statute, A.R.S. § 36-2223, is the clearest statement of the boundary we have found. A stretcher van may carry a convalescent or nonambulatory person to routine appointments who needs no medical monitoring. It may not carry anyone on IV fluids, needing oxygen that is not prescribed as self-administered, needing suctioning, with unevaluated injuries or acute conditions, or who "is being medically monitored at the sending facility and will continue to be medically monitored at the destination facility." It "shall not contain medical equipment or supplies or display any marking, symbols or warning devices that imply that it offers medical care or ambulance transportation," and it may not respond to a request that came through a public dispatch system. Violate it and the department may determine, after notice and a hearing, that you were operating an unregistered ambulance.

Regime 2: regulated through Medicaid or vehicle-for-hire rules. California defines a litter van as a vehicle for "patients with stable medical conditions who require the use of a litter or gurney," expressly "not routinely equipped with the medical equipment or personnel required for the specialized care provided in an ambulance." Litter vans "shall be operated by a certified driver and an attendant", two people, each holding current Red Cross Standard First Aid or equivalent. New York pays a "Stretcher Ambulette" category of service for a member who "is confined to bed, cannot sit in a wheelchair, and does not require medical attention/monitoring during transport," and, per its transportation manual, requires at least two employees.

Regime 3: prohibited. The American Ambulance Association's position paper opposing stretcher vans names Alabama, Michigan and Ohio as states that banned them outright, and notes some states treat them merely as vehicles for hire. That is undated advocacy material from an industry with an obvious stake, and we have not checked Alabama or Michigan law against it. It is consistent with Ohio's statute, which exempts from the ambulance definition only vehicles used solely for nonstretcher-bound people.

Before you buy a cot: email your state EMS office and Medicaid transportation unit, describe exactly the service you intend to run, and get the classification in writing. These rules move: Illinois revised its stretcher van operating rule effective November 1, 2024.

Reimbursement: does the tier actually pay?

Published Medicaid fee schedules are the only defensible public numbers. The rows below use North Dakota's NEMT schedule (data updated September 27, 2026), South Dakota's transportation schedule (effective July 1, 2026) and Colorado's NEMT schedule (rates effective July 1, 2026). Broker and MCO rates vary widely; private pay is a different market.

Mileage rules matter as much as base rates: an in-town South Dakota stretcher trip pays the $109.66 base alone. North Dakota's July 2025 schedule paid wheelchair mileage only past 15 miles; the current file is silent, so confirm with the state.

The stretcher premium is real in the Dakotas: North Dakota pays 5.4 times the wheelchair base rate, South Dakota 2.5 times. It is not universal. Colorado pays 1.45 times the wheelchair base, and with stretcher mileage below wheelchair mileage, a 12-mile trip pays $71.74 by stretcher against $67.02 by wheelchair, about 1.07 times; past about 17 loaded miles, stretcher pays less. Everywhere, the premium buys a second wage. A 90-minute round trip consumes three crew-hours, not 1.5, so South Dakota's $109.66 in town, or $148.81 with 15 loaded miles outside city limits, carries about $69 of direct labor ($18 an hour plus 28% burden) before vehicle, insurance, dispatch and overhead.

The comparison that should stop you: South Dakota pays a non-emergency BLS ambulance base of $280.09 plus $9.00 per loaded mile, with no city-limits restriction on ambulance mileage. That same 15-mile trip bills $415.09 as BLS, 2.8 to 3.8 times the stretcher rate depending on city limits. Where your state offers both paths, price the EMS provider license before settling for the stretcher van license.

Medicare is not a factor. It pays for ambulance service, not stretcher vans, and its bed-confinement test requires the beneficiary be unable to get up from bed without assistance, unable to ambulate, and unable to sit in a chair or wheelchair, all three. Build on Medicaid, MCO and facility contracts, and private pay.

Private pay is where stretcher service earns its reputation. One Chicago-area provider publishes $350 to $400 base plus $6.00 a mile after the first 5 miles, $380 to $430 for a 10-mile leg, plus $50 per leg on weekends. Medicaid pays about $68 for the same 10 miles in Colorado and $110 to $136 in the Dakotas. Know which business you are in before you start, and audit the difference, per our NEMT revenue auditing guide.

Staffing, injuries, and the number nobody budgets

Two-person crews are not a courtesy. Illinois, Oklahoma, California and New York mandate them, and physics does the rest: the three cots listed above weigh 92 to 125 lb empty, and you are loading a bed-confined adult onto one, out of a bedroom and up into a van.

In a NIOSH study of EMS workers treated in emergency departments (2010 to 2014), career EMS workers had 8.6 injuries and exposures per 100 full-time-equivalent workers, more than four times the rate for all workers. Ninety percent of body-motion injuries came from lifting, carrying or transferring patients or equipment, and sprains and strains were more than 40% of all injuries. In 2007, EMTs and paramedics had 349.9 injuries with days away from work per 10,000 full-time workers, about 2.9 times the all-private-industry average.

Your stretcher crew does EMS lifting work on an NEMT payroll. Weigh the roughly $6,365 gap between the refurbished manual and powered cots above against what one lost-time back injury does to your workers' comp premium; your carrier can price it. Formal lift and transfer training belongs in onboarding alongside securement; see our driver safety training guide.

Who your riders and referral sources actually are

Stretcher demand is narrow: bed-bound long-term care residents, post-surgical discharges going home or to a skilled nursing facility, hospice patients moving to inpatient units or home, bariatric riders who cannot be safely seated, and long-distance facility transfers.

Hospital discharge planners, SNF admissions directors, hospice coordinators and MCO case managers generate most of it, and few of them book two weeks out. Discharge transport is often same-day, and it cancels when the attending is slow to sign. That makes stretcher volume lumpy and hard to fill, and it is why a relationship with three or four discharge planners beats any marketing you will do; our client relationship management guide covers the cadence.

Should you add stretcher service? The arithmetic

Entry cost, honestly: in the listings above, cot, fastener kit and stair chair run about $4,700 to $15,900 before installation, plus any vehicle premium over a wheelchair van, licensing fees and an insurance step-up, and a second wage on every trip.

A hypothetical, not a forecast: a stretcher unit running four Medicaid trips a day at a $125 blended rate (close to North Dakota's 12-mile stretcher trip) grosses $125,000 a year over 250 days. Two crew at $18 an hour plus 28% burden, eight hours a day, 250 days, is about $92,000. That leaves about $33,000 for vehicle, insurance, fuel, maintenance, dispatch and overhead; a $79,900 van spread over five years takes about $16,000 of it. Thin, and only if you actually get four trips a day. In Colorado, at about $72 a trip, the same unit grosses about $72,000 and does not cover the crew. A second wheelchair van with one driver can be the cleaner return; run both.

Stretcher service earns its place when at least two of these are true:

• Your state has an achievable, explicit stretcher license, not an ambulance license requiring a clinical program.
• You have a named discharge planner, SNF or hospice relationship that will reliably produce three or more trips a day.
• A meaningful share of volume can be private-pay or facility-contract at several times your Medicaid stretcher rate.
• You can staff a second attendant without pulling a driver off wheelchair runs. The hidden cost of stretcher service is the wheelchair trips you stopped covering.

Do not add stretcher service to win one facility contract. Facilities change vendors, and you are left holding a cot, a fastener, a license renewal and a van that does one thing.

What this means for your P&L

Stretcher is a high-revenue, low-utilization, high-liability line. Depending on your state's schedule it pays from barely more than wheelchair to five times as much per trip, and it roughly doubles labor per trip, so the margin lives in your state's rate, trip count and payer mix. On Medicaid alone at four trips a day it is thin in a well-paying state and a loss in Colorado, with real injury exposure either way. On private pay and facility contracts at the same volume it can be the most profitable thing in your fleet. The regulatory risk is not a cost, it is binary, and the only decision here you cannot fix later.

Next actions

1. Email your state EMS licensing office and Medicaid transportation unit this week. Describe the exact service, bed-confined, stable, no monitoring, and ask which license applies. Keep the answer in writing.
2. Price the EMS provider license path too. In Colorado and the Dakotas, non-emergency BLS pays roughly three times the stretcher rate or more; where that holds, the pricier license may be the cheaper business.
3. Call your commercial auto and workers' comp carriers before you shop for a cot. Specialist NEMT brokers such as SWAN Insurance and Bridgeway can tell you whether stretcher work moves you to a new underwriter and class code.
4. Get two quotes on a certified fastener install into structural floor. Do not let a general upfitter improvise it.
5. Build the pro forma at three trips a day, not eight, with separate lines for private-pay and Medicaid volume.
6. Confirm your dispatch platform can price a stretcher tier and assign a two-person crew to one trip. Whether you run Bambi, MediRoutes, Tobi Cloud, RouteGenie, TripMaster or another platform, test the two-person assignment, since single-driver assumptions are baked into a lot of NEMT software.

This is not legal, tax or investment advice. Rules and rates vary by state and change often; confirm with counsel, a CPA or your state Medicaid agency before you act.

Gurney vs stretcher: common questions

Is a gurney the same as a stretcher?

In non-emergency medical transportation, yes. The words describe the same service. Your state regulations, Medicaid enrollment and billing codes almost always say stretcher, so use that word on paperwork and gurney in marketing.

What is the difference between a gurney van and a wheelchair van?

A gurney van carries a roll-in cot that locks into a floor fastener, usually needs a two-person crew, and in some states needs a different license or ambulance-level registration. A wheelchair van carries a seated rider secured in a wheelchair with a single driver.

Does stretcher transport pay more than wheelchair transport?

Usually, but by how much depends on the state. Current Medicaid stretcher base rates run about 1.45 times wheelchair in Colorado, 2.5 times in South Dakota and 5.4 times in North Dakota; on a 12-mile Colorado trip the gap is under $5. The second crew member, the cot and the insurance eat much of any difference, so run the math above before adding the tier.

Do I need an ambulance license to run stretcher trips?

It depends on the state. Some license stretcher vans as NEMT, others treat any stretcher transport as ambulance service. Check your state EMS agency before your first trip; see the regulatory section above.

Related reading

• NEMT Wheelchair Securement & Gurney Safety: The Complete Guide
• Audit Trail Rules For NEMT Software
• How to Start a NEMT Business: The Complete 2026 Guide to Licensing, Costs & Launch