No, "Treatment Without Transport" (TNT) fees are not part of the federal Medicare fee schedule. In fact, under standard federal Medicare guidelines, if an ambulance responds to a call but does not ultimately transport the patient to a hospital or medical facility, the legally allowable reimbursement rate is effectively $0.
The Local Wild West
Because there is no federal mandate or reimbursement structure for non-transports, TNT fees operate in a regulatory "Wild West." These fees are established locally—usually voted on by city councils, authored by municipal fire departments, or drafted into contracts with private ambulance vendors.
This leads to incredibly disjointed billing experiences across the country. In some states or counties, calling 911 for a medical assessment is completely subsidized by local taxes. In others—like San Francisco for example—the local fire department is legally authorized to charge hundreds of dollars simply for showing up and assessing your vitals, even if you refuse transport and drive yourself to the clinic.
What Drives These Fees?
Municipalities that enforce TNT or "Assessment Fees" argue that the cost of dispatching a multi-ton emergency vehicle and a team of highly trained paramedics is substantial regardless of whether the patient actually needs a hospital bed. These local fees are an attempt to recoup the operational costs of "false alarms" and non-critical 911 deployments.
What this means for you: Because these fees are hyper-local, our calculator relies on verified municipal data matrices (where available) to alert you to TNT fees in your specific city. If you cannot find data for your locality, you must contact your local Fire Department's billing office directly to confirm their non-transport policies.