G2251 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 G2251, 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. 10 of the 16 states list more than one rate for G2251, 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 16 states, 1 publish G2251 per hour, and 15 schedules print no unit at all (a flat amount per service).
• Per hour. Time-based units are converted to an hour of service (four 15-minute units make an hour). 1 of the 16 states bill G2251 by time.
• Managed-care plans. The rule the state sets for its plans on this rate. What each rule means is explained below.
• % of Medicare. Medicare amounts exist for G2251, but no state's Medicaid unit matches Medicare's billing unit closely enough to compute a percentage.
• Source and date. Each Source link opens the state's own document; “since” is the date the rate took effect.

Published rates for G2251 run from $3.13 in Kansas to $47.49 in Texas. The two publish it in different units (hour 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 $10.92 and half pay less. The usual reasons for a spread like this in private duty nursing rates:

• Registered nurse and licensed practical nurse services carry different rates, and many states add an amount for ventilator, tracheostomy or other high-acuity care.
• Group nursing, where one nurse cares for more than one patient, is paid at a reduced rate in many states.
• Nursing rates compete with hospital wages, so states facing shortages have raised them out of step with the rest of the schedule.

Timing matters too. 8 states set the current rate for G2251 in 2026 or later, while 3 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.

What a plan pays for G2251 is negotiated privately, but the state decides how much room there is to negotiate. Here is how the rules break down across the 16 states.

In 1 state, the published rate binds plans: a floor, a pass-through or a state-set rate. In 8 states, 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 6 states is not classified yet.

• Plans negotiate; the published rate applies out of network (8 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.
• 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.
• 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.

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 Texas managed care.

G2251 is a HCPCS Level II professional services code in the private duty nursing line, billed mostly by home nursing agencies and independent nurses. G codes describe professional services and procedures that have no CPT code, or that payers define more narrowly. Many are timed, so check the unit before comparing.

Shift nursing is billed in 15-minute units under some codes and per hour under others, so convert to an hourly rate before comparing. Prior authorization usually sets the number of hours per week that can be billed.

Medicare's 2026 physician fee schedule pays $13.35–$15.60 for G2251 (non-facility), depending on the Medicare locality. That is a useful reference point, but Medicare and Medicaid can define the unit differently, so compare only where the units match.

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.