Keeping Emergency Medical Care Available, Reliable, and Sustainable

Metro Fire is our community's protector, neighbor, and healthcare provider—present during life's worst moments, invested in our community's best outcomes, and accountable to the people we serve. Every day, our firefighters and paramedics respond with the personnel, equipment, and expertise needed to deliver lifesaving emergency medical care.

To ensure these services remain available, reliable, and sustainable, Metro Fire periodically reviews the actual cost of providing emergency medical services. These reviews help keep fees fair, transparent, legally compliant, and aligned with the true cost of service while preserving the high-quality emergency response our community depends on.

In 2025, Metro Fire completed a comprehensive Ambulance and First Responder Fee Study that evaluated the costs of staffing, equipment, medical supplies, training, emergency readiness, ambulance transportation, and regulatory requirements. Following a public review process, the Metro Fire Board of Directors adopted an updated EMS Fee Ordinance and Fee Schedule, effective July 1, 2026.

Why Is Metro Fire Updating EMS Fees?

Emergency medical response is one of Metro Fire's most critical public safety services. Every day, firefighters and paramedics respond to emergencies with advanced life support, specialized equipment, ambulances, and 24/7 readiness.

As call volumes, medical standards, equipment costs, and training requirements continue to increase, EMS fees must accurately reflect the cost of providing service. Updating the fee schedule supports firefighter-paramedic staffing, ambulances and medical equipment, medical supplies and medications, training, emergency communications, regulatory compliance, and the readiness required to respond to emergencies.

Metro Fire's commitment remains unchanged: providing rapid, high-quality emergency medical care whenever it is needed. The updated EMS Fee Schedule helps ensure these services remain available, reliable, and sustainable for the communities we serve.

What Is Changing?

Metro Fire has adopted an updated EMS Fee Study, EMS Fee Ordinance, and EMS Fee Schedule. Together, these documents establish the cost of service, billing practices, patient protections, and the fees associated with emergency medical treatment and ambulance transportation.

What EMS Fees Support

• 24/7 firefighter-paramedic staffing
• Ambulances and emergency response vehicles
• Advanced life support equipment and technology
• Medical supplies, medications, and protective equipment
• Emergency dispatch and communications systems
• Ongoing training, certification, and continuing education
• Equipment maintenance and replacement
• Mobile Integrated Health programs
• Readiness to respond at a moment’s notice, every day of the year
EMS fees help recover a portion of these costs from service users rather than relying solely on taxpayers.

How Does This Affect Me?

Most residents will only encounter EMS fees if they receive emergency medical services. Examples include receiving assessment and treatment from firefighters or paramedics, being transported by ambulance, or receiving certain specialized EMS services. If you never use EMS services, these fees generally do not apply to you.

When Are EMS Fees Charged?

Ambulance Transport, Treatment on Scene, Automatic Aid with Transport, Mobile Integrated Health (MIH), and related medically necessary add-on services such as mileage, oxygen administration, and cardiac monitoring.

What Are the Updated EMS Fees?

Effective July 1, 2026:
Ambulance Transport: $3,495
Automatic Aid with Transport: $2,963
Treatment on Scene: $532
Mobile Integrated Health Service: $3,388
MIH Supplemental Service: $1,165
Mileage: $53/mile
Oxygen: $194
Cardiac Monitor: $148

Actual patient responsibility may vary based on insurance coverage, Medicare, Medi-Cal, contractual billing limitations, and applicable laws.

Patient Protections

Your health and safety will always come first. During a medical emergency, no one should hesitate to call 911 because of concerns about the cost of care.

Metro Fire is committed to providing compassionate emergency medical services while ensuring our billing practices are fair, transparent, and consistent with state law. Our billing process is designed to recover the reasonable cost of providing emergency medical services while protecting patients and offering assistance to those who need it.

Patient Protections Include:

• Balance Billing where Applicable – State law and insurance agreements limit or prohibit balance billing in many situations, helping protect patients from unexpected medical bills.
• Low-Income Assistance Program – Patients experiencing financial hardship may qualify for reduced or waived charges. Individuals or their authorized representative may submit a Low-Income Assistance for Medical Billing application for review. Applications are available through Metro Fire's Ambulance Billing Information webpage.
• Transparent Billing – All charges are based on the documented patient care provided and the EMS Fee Schedule adopted by the Metro Fire Board of Directors.
• Billing Questions or Disputes – Patients who have questions or wish to dispute charges may contact the Wittman billing at 800-906-6552. 

Frequently Asked Questions

Will my insurance still be billed?
Yes, in accordance with applicable laws and contractual requirements.

What if I cannot afford my bill?
Low-income assistance and hardship review programs are available.

Are these new taxes?
No. EMS fees are service-related user fees and apply only to emergency medical services provided to a patient.

Why doesn't Metro Fire simply pay for EMS services through taxes?
User fees help recover a portion of service costs from those who receive services rather than placing the entire burden on taxpayers.

Why is treatment on scene billable?
Resources, personnel, equipment, and readiness are required whether or not a patient is transported.

Why are fees increasing?
The cost of staffing, equipment, training, supplies, and readiness has increased.

Does this affect property taxes?
No.

How are fees determined?
Fees are based on the Ambulance and First Responder Fee Study.

 

Transparency Center 

EMS Fee Study PowerPointEMS Fee OrdinanceEMS Fee SchedulePrevious Ordinance RescissionPublic Hearing Notices

 

Timeline

November 2025 – Fee Study Completed
May 14, 2026 – Board Accepts EMS Fee Study
May 28, 2026 – Board Adopts EMS Fee Ordinance and Fee Schedule
July 1, 2026 – New EMS Fee Schedule Takes Effect

Our Commitment to the Community

Providing exceptional emergency medical care requires ongoing investment in highly trained personnel, ambulances, lifesaving medical equipment, communications systems, training, and emergency readiness. Periodic review of fees helps ensure they reflect the documented cost of providing service and support a sustainable emergency medical system.

Metro Fire is committed to being a responsible steward of public resources by making transparent, fiscally responsible decisions focused on the long-term needs of the community. This review provides a clear, data-driven foundation for the adopted fee schedule and helps ensure that the cost of service is shared fairly and consistently.

We encourage community members to review the study, learn more about the fee update, and participate in the public process. By planning responsibly today, we can continue providing reliable, high-quality emergency medical care whenever our community needs us.

Questions?

EMS Division
Sacramento Metropolitan Fire District
10545 Armstrong Avenue, Suite 200
Mather, CA 95655
(916) 859-4300