T1021 Medicaid reimbursement rate by state (2026)

• Order. States are listed from the highest published rate to the lowest. A like-for-like rank only counts states that use the same unit: 12 of the 14 states publish T1021 per visit, enough to rank them against each other.
• Medicaid rate. The most the state's fee-for-service program pays for one unit, as published. 8 of the 14 states list more than one rate for T1021, 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 14 states, 12 publish T1021 per visit, 1 per 1 unit per visit and 1 per 15 min.
• Per hour. Time-based units are converted to an hour of service (four 15-minute units make an hour). 1 of the 14 states bill T1021 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. No Medicare physician fee schedule amount is on file for T1021, 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 T1021 run from $4.70 in Maryland to $139.93 in Utah. The two publish it in different units (visit versus 15 min), so part of that gap is the unit rather than the price. Half the states pay more than the median of $42.54 and half pay less. The usual reasons for a spread like this in home health rates:

• Some states pay home health per visit and others per 15 minutes or per hour, and Medicare pays a different way altogether.
• 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.

Timing matters too. 6 states set the current rate for T1021 in 2026 or later, 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 T1021. 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, the published rate binds plans: a floor, a pass-through or a state-set rate. In 6 states, plans negotiate and the published rate is a benchmark or out-of-network default (or a ceiling). The rule for the remaining 5 states is not classified yet.

• Plans negotiate; the published rate applies out of network (5 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.
• Plans are expected to pay at least the published rate (1 state). Treat the published rate as a strong anchor, and confirm the minimum is written into your own plan agreement.
• Plans may pay no more than the published rate (1 state). Expect offers at or below the published rate. Higher payment would have to come from something other than the base rate, such as a quality or value-based arrangement.

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.

T1021 is a HCPCS Level II state Medicaid agency code in the home health line, billed mostly by certified home health agencies. T codes were created for state Medicaid agencies, for services such as personal care, private duty nursing, case management and waiver services. Each state defines how the code is used and paid, so units vary from 15 minutes to a month.

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.