H1004 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 H1004, 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 7 states list more than one rate for H1004, 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. None of the 7 schedules prints a separate unit for H1004, so each amount is a flat payment for one service as the code defines it.
• Per hour. H1004 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 H1004, 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 H1004 run from $9.84 in Iowa to $212.94 in Utah, a 21.6x gap in the same unit. Half the states pay more than the median of $52.79 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. 1 state set the current rate for H1004 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.

Most Medicaid members are in managed-care plans, and plans don't publish their provider fee schedules. For H1004, the public signal is the rule each state sets for its plans, recorded on each rate above.

In 2 states, the published rate binds plans: a floor, a pass-through or a state-set rate. In 2 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 2 states is not classified yet.

• Plans negotiate; the published rate applies out of network (2 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.
• Plans must pay at least the published rate (2 states). 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 Utah managed care.

H1004 is a HCPCS Level II behavioral health code in the home health line, billed mostly by certified home health agencies. H codes were created for state Medicaid agencies to bill mental health and substance use services. Each state defines the unit, which may be 15 minutes, an hour, a day or an episode.

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.