421 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 421, 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 6 states list more than one rate for 421, 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 6 states, 2 publish 421 per visit and 1 per one visit up to 2 ½ hours, and 3 schedules print no unit at all (a flat amount per service).
• Per hour. 421 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 421, 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 421 run from $84.14 in Connecticut to $191.77 in Oregon. The two publish it in different units (no unit printed versus visit), so part of that gap is the unit rather than the price. Half the states pay more than the median of $127.22 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. None of the states changed its rate for 421 in 2026, while 2 states still pay a rate that took effect in 2022 or earlier. 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 421. 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 1 state, the published rate binds plans: a floor, a pass-through or a state-set rate. In 1 state, plans negotiate and the published rate is a benchmark or out-of-network default. In 1 state, the service is paid outside the plans or through a state-directed payment. The rule for the remaining 3 states is not classified yet.

• Plans negotiate; the published rate applies out of network (1 state). 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.
• Plans must pay at least the published rate (1 state). The published rate is your floor. Negotiate up from it, and if a plan pays less, the contract provision is the basis for a payment dispute.
• Paid by the state, outside the plans (1 state). Bill the state's Medicaid program, not the plan, at the published rate. There is no plan contract to negotiate for this service.

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 Oregon managed care.

421 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.