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

A stretcher trip pays two to five times what the same distance pays on the wheelchair tier. It also requires two crew members instead of one, a five-figure equipment stack, and — in a meaningful number of states — a license you probably do not have. Get the classification wrong and your state EMS agency does not fine you for a paperwork error. It determines that 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, stretcher, cot: the honest answer

In US non-emergency medical transportation, "gurney" and "stretcher" mean the same thing. The split is regional and colloquial — "gurney" is more common on the West Coast and in consumer marketing, "cot" is what EMS people say, "stretcher" is what most state regulations 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 own the category.
• Transport stretcher. In-facility equipment — the flat, high-side units that move a patient from a room to radiology. Some are rated to 1,000 lb, 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 — different fastener geometry, lift plan and crew count.
• Stair chair. Not a stretcher, but you cannot run stretcher service 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 license "stretcher vans." New York pays a category called "Stretcher Ambulette." Ohio's ambulette rules define the client as someone "who requires the use of a wheelchair or who is confined to a wheelchair" — 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 current listings as of mid-2026. Refurbished is the norm here — the used market is deep because ambulance services cycle cots on a schedule.

The fastener is the line item first-time buyers under-budget. Stryker's 6370/6371 antler-and-rail systems 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. It is the first thing a state inspector puts a hand on. A powered cot roughly doubles the cot line; 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 in the country 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, doors operable from inside and out, interior and portable lighting, climate control, 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, a forward-facing 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 148" mid-roof wheelchair van with a 34" rear-entry lift starting at $77,900 plus tax, registration and delivery, and lists the gurney build on the same platform as contact-for-pricing. Avan Mobility publishes $125,000–$225,000 for a heavily customized mobile response van — 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 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, plus anyone whose condition prevents cooperation — dementia and elopement risk are named. Oklahoma runs a separate Stretcher Van Service license: $600 initial application, $20 per van beyond two, $150 per substation, and an equipment list including an AED, secured oxygen and an AMD-compliant elevating gurney. It also restricts where you may operate — EMS regions, ambulance districts, or counties over 500,000 population.

Arizona's statute, A.R.S. § 36-2223, is the clearest statement of the boundary anywhere. 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 non-self-administered oxygen or suctioning, with undiagnosed injuries or acute conditions, or who "needs to be 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 public dispatch system. Violate it and the department may determine 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 must "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."

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 — but it is directionally consistent with Ohio's ambulette rules.

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. Broker and MCO rates vary widely; private pay is a different market.

The stretcher premium is real — North Dakota pays 5.4x the wheelchair base rate, South Dakota 2.5x. But it buys a second wage. A 90-minute round trip consumes three crew-hours, not 1.5, so South Dakota's $109.66 plus 15 loaded miles at $2.61 — $148.81 — carries roughly $55–$70 of direct labor 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. That same 15-mile trip bills $415.09 as BLS — 2.8x the stretcher van rate. 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. Published consumer rates run $300–$525 base plus $5–$16 per mile — a 10-mile trip at $350–$685, with 1.5x weekend and 2.25x holiday multipliers. That is the same trip Medicaid pays $150 for. 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 and California mandate them, and physics does the rest: a cot weighs 74 to 125 lb empty, and you are loading a bed-confined adult onto it, out of a bedroom and up into a van.

Career EMS workers show 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. Across 2003–2007, EMS workers had a lost-work-day rate of 3.49 per 100 full-time workers, nearly three times the all-private-industry rate.

Your stretcher crew does EMS lifting work on an NEMT payroll. The $4,363 gap between a manual cot and a powered one is less than one lost-time back injury in most comp jurisdictions. Formal lift and transfer training belongs in onboarding alongside securement; see our driver safety training best practices.

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 essentially all of it, and none of them books two weeks out. Discharge transport is same-day, often same-hour, and cancels when the attending is slow to sign. That is why stretcher units run 2–5 trips a day instead of 10, and 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: cot $3,300–$8,400, fastener $1,200–$1,900, stair chair $1,600, the vehicle premium over a wheelchair van, licensing fees and an insurance step-up — call it $10,000–$15,000 on top of the van, plus a second wage on every trip.

A stretcher unit running four Medicaid trips a day at a $150 blended rate grosses roughly $150,000 a year. Two crew at $19/hour fully burdened, eight hours a day, 250 days, is about $76,000. That leaves roughly $74,000 for vehicle, insurance, fuel, maintenance, dispatch and overhead. It works — barely — and only if you actually get four trips a day. The same capital in a second wheelchair van running 10 trips a day with one driver is a cleaner return in most markets.

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 $300+ per trip rather than Medicaid at $110.
• 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. It roughly doubles revenue per trip and roughly doubles labor per trip, so the margin lives in trip count and payer mix. On Medicaid alone at four trips a day it is thin, with real injury exposure. On private pay and facility contracts at the same volume it is 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. If your state pays BLS non-emergency at 2–3x the stretcher rate, 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. Bambi, MediRoutes, Tobi Cloud, RouteGenie and TripMaster all handle multi-tier NEMT scheduling; verify the two-person assignment specifically, since single-driver assumptions are baked into a lot of NEMT software.