0551 Medicaid reimbursement rate by state (2026)

• Order. States are listed from the highest published rate to the lowest. No single unit is shared by 8 or more states for 0551, so the order is by published amount and is not a like-for-like rank.
• Medicaid rate. The most the state's fee-for-service program pays for one unit, as published. 3 of the 5 states list more than one rate for 0551, by modifier, provider type or setting; the table shows the one that matches the provider level and setting used across states, without add-ons.
• Unit. Of the 5 states, 2 publish 0551 per visit, and 3 schedules print no unit at all (a flat amount per service).
• Per hour. 0551 is not billed in time units in these states, so no hourly figure is shown.
• Managed-care plans. The rule the state sets for its plans on this rate. What each rule means is explained below.
• % of Medicare. No Medicare physician fee schedule amount is on file for 0551, so there is no percentage.
• Source and date. Each Source link opens the state's own document; “since” is the date the rate took effect.

Published rates for 0551 run from $123.87 in Wyoming to $181.02 in Virginia. The two publish it in different units (visit versus no unit printed), so part of that gap is the unit rather than the price. Half the states pay more than the median of $155.39 and half pay less. The usual reasons for a spread like this in home health rates:

• Rates differ by discipline: skilled nursing, home health aide, physical, occupational and speech therapy.
• Rural adjustments and add-ons for travel or high-acuity patients vary by state.
• Some states pay home health per visit and others per 15 minutes or per hour, and Medicare pays a different way altogether.

Timing matters too. 3 states set the current rate for 0551 in 2026 or later. A state that has not updated its rate in years will drift down the ranking as others raise theirs.

No managed-care plan publishes what it pays for 0551. What is public is the rule each state's plan contracts set, and that rule decides how much the published rate matters when you contract with a plan.

In 3 states, plans negotiate and the published rate is a benchmark or out-of-network default. The rule for the remaining 2 states is not classified yet.

• Plans negotiate; the published rate applies out of network (3 states). In-network rates can be above or below the published rate. The published rate is the benchmark both sides know, and the fallback if no contract is signed.

Plan-negotiated rates are never estimated here. To see the rule and its citation for a particular state, open that state's managed-care page, for example Virginia managed care.

0551 is a revenue code in the home health line, billed mostly by certified home health agencies. Revenue codes identify a facility's accommodation or cost center on an institutional claim. Day-rate services such as hospice and nursing facility care are billed per day under them.

Home health visits are billed per visit or in 15-minute units depending on the state and the code. Prior authorization often sets the number of visits that can be billed.

Before billing, confirm the rate, unit and any modifier with the state's current schedule or the plan: the amounts here are as published, not a guarantee of payment.