Kootenai County EMS Funding / Billing Rates
Ambulance Billing and Tax Dollars
Why does Kootenai County EMS charge for ambulance services and also collect property tax revenue? Great question — and we’re glad you asked.
Ambulance Billing
Kootenai County Emergency Medical Services System (KCEMSS) was designed to recover much of its operating costs through user fees rather than fully funding EMS services through property taxes.
However, KCEMSS has limited control over how much it is paid for most ambulance transports.
In 2024:
- 61% of patients were covered by Medicare
- 12% were covered by Medicaid
These government programs determine:
- The total allowable payment for ambulance services
- The portion assigned to the patient as their responsibility
- The amount that must be written off as a contractual adjustment
Medicare allowable rates (Medicare payment plus patient responsibility) are significantly lower than the actual cost of providing ambulance services. This is a well-documented national issue. Although Medicare conducted a multi-year ambulance cost data study, no major reimbursement changes had been implemented as of this writing.
In Fiscal Year 2024, KCEMSS wrote off more than $4.7 million in contractual adjustments due to government payer limits.
Because these amounts cannot be recovered from Medicare or Medicaid, KCEMSS must offset the shortfall using:
- Property tax revenue
- Grants
- Other supplemental funding sources
Tax Dollars
KCEMSS operates as the Ambulance District for Kootenai County. Property owners will see this line item on their annual property tax assessment.
In FY2024:
- KCEMSS received $3.7 million in property tax revenue
- This was $1 million less than the amount written off in contractual adjustments that same year
What Does the Levy Rate Mean?
For 2024 the Ambulance District levy rate was: 0.00007340
(Just over $0.07 per $1,000 of assessed value.)
For example:
- A home with a taxable assessed value of $500,000 would pay $36.70 per year to support ambulance services.
KCEMSS maintains one of the lowest ambulance district levy rates in the State of Idaho.
Why Both Billing and Taxes?
Ambulance billing alone does not cover the true cost of operations due to government reimbursement limits. Property tax revenue helps ensure:
- 24/7 emergency response coverage
- Trained paramedics and EMTs
- Equipment and ambulance readiness
- Community emergency preparedness
This blended funding model allows KCEMSS to provide reliable emergency medical services while keeping the tax burden comparatively low.
Current Billing Rates
KCEMSS - Ambulance Rate Increase. Approved by BOCC 7/14/2026, Res. # 2026-76
| Charge code | Description | Rates 10/1/2021 - 9/30/2026 | New rates as of 10/1/2026 | Rate change |
|---|---|---|---|---|
| Base Rates | ||||
| A0429 | BLS Emerg Base Rate | $642.00 | $668.00 | $26.00 |
| A0429 | BLS Emerg Base Rate - NR | $753.00 | $784.00 | $31.00 |
| A0428 | BLS Non Emerg Base Rate | $586.00 | $610.00 | $24.00 |
| A0428 | BLS Non Emerg Base Rate - NR | $697.00 | $725.00 | $28.00 |
| A0427 | ALS Emerg Base Rate | $837.00 | $871.00 | $34.00 |
| A0427 | ALS Emerg Base Rate - NR | $948.00 | $986.00 | $38.00 |
| A0426 | ALS Non Emerg Base Rate | $780.00 | $812.00 | $32.00 |
| A0426 | ALS Non Emerg Base Rate - NR | $891.00 | $927.00 | $36.00 |
| A0433 | ALS2 Emerg Base Rate | $948.00 | $986.00 | $38.00 |
| A0433 | ALS2 Emerg Base Rate - NR | $1,059.00 | $1,102.00 | $43.00 |
| A0434 | CCT Specialty Care Rate | $1,114.00 | $1,159.00 | $45.00 |
| A0434 | CCT Specialty Care Rate - NR | $1,225.00 | $1,274.00 | $49.00 |
| A0998 | Treat - No Transport | $224.00 | $233.00 | $9.00 |
| A0998 | Treat - No Transport - NR | $335.00 | $349.00 | $14.00 |
| Mileage | ||||
| A0425 | SCT Mileage (per mile) | $23.00 | $24.00 | $1.00 |
| A0425 | BLS Mileage (per mile) | $17.50 | $18.20 | $0.70 |
| A0425 | ALS Mileage (per mile) | $17.50 | $18.20 | $0.70 |
| Miscellaneous Charges | ||||
| A0420 | BLS Ambulance Wait Time (per 30 min) | $67.00 | $70.00 | $3.00 |
| A0420 | ALS Ambulance Wait Time (per 30 min) | $90.00 | $94.00 | $4.00 |
| A0420 | CCT Ambulance Wait Time (per 30 min) | $112.00 | $117.00 | $5.00 |
| A0424 | Extra Ambulance Attendant | $168.00 | $175.00 | $7.00 |
| A0432 | PI - Paramedic Intercept | $224.00 | $233.00 | $9.00 |
| A0432 | PI - Paramedic Intercept - NR | $335.00 | $349.00 | $14.00 |
| Combined | Standby Rate for Events per Hour | $261.85 | $273.00 | $11.15 |
Hospice base rate: $10.00 over Medicare allowable/mileage not discounted.
Definitions
- NR = Non-Resident Rate
- BLS = Basic Life Support
- ALS = Advanced Life Support
- CCT or SCT = Specialty Care (Also referred to as Critical Care)
Pay Your Bill
Kootenai County EMS partners with Systems Design, LLC for billing services.
Access the EMS Patient Website to view patient account information and billing details.