Home health Medicaid rates in the District of Columbia start with the highest skilled nursing rate in the country. DC Medicaid pays $155.16 per 15 minutes for a home health nurse visit on code G0299, which is $620.64 an hour. That ranks 1st of 14 ranked states and is 547.4% above the national median of $23.96.
The rate took effect on 2026-10-01 under Transmittal 26-25, Skilled Nursing Rate Changes Effective October 1, 2026. It is billed with modifier TD. No other state comes close: Texas is second at $98.92 and Michigan third at $89.08 on G0493.
DC has rates for four of the five home health disciplines in this comparison, and all four are ranked:
| Service | Code | DC rate | Per hour | Rank | vs national median |
|---|---|---|---|---|---|
| Nurse visit | G0299 (TD) | $155.16 / 15 min | $620.64 | 1 of 14 | +547.4% |
| Physical therapy | G0151 (U4) | $31.79 / 15 min | $127.16 | 8 of 19 | +5.5% |
| Occupational therapy | G0152 (U4) | $31.79 / 15 min | $127.16 | 7 of 18 | +8.3% |
| Speech therapy | G0153 (U4) | $31.79 / 15 min | $127.16 | 8 of 16 | +7.7% |
The structure is lopsided. Skilled nursing is ranked first by a wide margin, while therapy sits just above the median at a single rate across PT, OT and speech.
Every DC home health rate in this comparison is paid per 15-minute unit, and each carries a modifier. The nurse visit bills with TD, the modifier that identifies registered nurse services, and the therapy codes bill with U4.
Why the modifier matters
In DC, the modifier is part of the price. The same base code can carry a different rate, or no rate, without the right modifier, and a claim with the wrong one can be priced incorrectly or denied. Billing teams should build the modifier into their charge master for each discipline rather than relying on staff to add it claim by claim.
Unit billing and visit length
Because the District pays by the unit, revenue tracks documented minutes. A 45-minute RN visit bills three units of G0299; a short visit bills fewer. Accurate start and end times are therefore the most important field on a DC home health visit note.
A rate of $155.16 per 15 minutes changes the economics of skilled nursing visits. The DC median wage for registered nurses in May 2025 was $49.30, slightly above the US median of $46.90. Against a $620.64 hourly rate, that wage is 11.3% of the rate, leaving $550.57 an hour after a loaded wage.
For comparison, the rest of the national nurse ranking is far lower. Delaware pays $49.07 per 15 minutes and Nevada $28.46. At the bottom are Pennsylvania ($16.55 on T1002), Maine ($16.48) and California ($15.21).
For a DC agency, the nursing rate makes skilled visits the clear anchor of a Medicaid home health business. Licensed practical nurses earn a DC median of $36.42 (US $30.96), and code G0300 also appears in the DC coverage rules. The practical question is whether a visit needs an RN; matching the licence to the task keeps the agency compliant and protects the high-value RN line for the work that requires it.
DC pays $127.16 an hour for all three therapy disciplines. That places it in the upper half without reaching the leaders:
- Physical therapy (G0151): 8th of 19, against a median of $120.52. Michigan leads at $343.72 and Utah follows at $330.48.
- Occupational therapy (G0152): 7th of 18, against a median of $117.42.
- Speech therapy (G0153): 8th of 16, against a median of $29.50 per 15 minutes. Missouri leads at $137.61.
The single rate simplifies billing but treats disciplines with different wage levels the same way, which shows up in the margins below.
The margins after a loaded wage are steady across therapy disciplines: $57.70 an hour for physical therapy (wage 54.6% of the rate), $52.56 for occupational therapy (58.7%) and $52.41 for speech therapy (58.8%). DC therapist wages are above US medians for OT ($52.49 against $48.24) and speech ($52.59 against $47.05), and close to it for PT ($48.87 against $49.40).
Reading the gap between nursing and therapy
The contrast is the defining feature of DC home health. A nursing hour leaves $550.57 after wages; a therapy hour leaves roughly a tenth of that. An agency that offers both lines will find its therapy program funded largely by its nursing program, not the other way round. That is not a reason to drop therapy, which patients and referral sources expect, but it is a reason to staff therapy tightly and to manage authorization carefully.
Home health aides earn a DC median of $20.53, the highest relative premium over the US median of any role in this comparison.
DC's coverage rules carry detailed prior authorization conditions on most home health codes:
- G0153 (speech therapy): 45 prior authorization rules.
- G0152 (occupational therapy): 30.
- G0151 (physical therapy): 22.
- G0299 (RN visit): 13.
- G0300 (LPN visit): 9.
- G0154: none.
Therapy services, especially speech, carry the most authorization conditions. An agency adding therapy in DC should expect intake and authorization staffing to be a real cost, which narrows the therapy margins above. The practical defence is a written authorization workflow by code, a tracker for expiring approvals, and a rule that no visit is scheduled beyond the authorized units.
The District has issued a steady run of home health notices in 2025 and 2026:
- Transmittal 26-25, effective October 1, 2026: skilled nursing rate changes.
- Transmittal 26-16, effective 2026-07-01: rate notice for home health aide services.
- DC Register fee schedule updates for home health services, published 2026-05-29, alongside a proposed State Plan amendment governing reimbursement for home health services.
- Proposed rulemaking on private duty nursing reimbursement, published 2026-05-22.
- Transmittal 25-34, effective 2026-01-01: rate changes for home health aide services.
The living wage cycle
Earlier notices explain the rhythm. Transmittal 25-16 applied living wage rate changes for aide services on July 1, 2025, and Transmittal 24-40 applied a living wage increase on January 1, 2025. DC aide rates move whenever the District living wage moves, usually twice a year. Skilled nursing follows its own annual cycle: Transmittal 25-24 changed nursing rates on October 1, 2025, and Transmittal 26-25 did the same a year later, so October is the month to re-check the G0299 rate. Aide rates changed twice in 2026, but no aide visit rate is on file for this comparison, so DC does not appear in the aide ranking.
DC has 6 plans on file, including AmeriHealth Caritas District of Columbia, MedStar Family Choice DC and Health Services for Children with Special Needs. No managed-care rule is classified for home health in DC, so the published DHCF fee schedule is the reference rate when negotiating with plans.
The plan landscape also shifted in 2026. Transmittal 26-19 recorded that Wellpoint DC exited and its enrollees were auto-assigned to AmeriHealth Caritas DC effective August 1, 2026. Agencies that served Wellpoint members should confirm their AmeriHealth Caritas contracts and authorizations cover those patients. See the DC managed-care page for plan-by-plan detail.
DC's nursing rate stands apart from the region. Delaware is fourth nationally at $49.07 per 15 minutes, less than a third of the DC figure, and Maryland agencies work under a different schedule entirely. Agencies operating across the District line should budget each jurisdiction separately; the same nurse visit is worth very different amounts on either side.
For related lines, see the DC private duty nursing rates, where a reimbursement rulemaking is also in progress.
For budgeting, separate the nursing line from the therapy line. They behave like two different businesses with very different margins.
For compliance, treat the modifier and the authorization as part of the rate. A missing TD or U4, or an expired approval, costs the full visit.
For hiring, the wage data points in one direction. DC pays above-median wages for every clinical role except physical therapy, so recruiting is expensive, but the nursing rate leaves more than enough room to compete for registered nurses. Therapy and aide roles have far less room, and those are the positions where pay offers need the closest check against the rate.
For negotiations with commercial payers and Medicare Advantage plans, the DC Medicaid nursing rate is an unusually strong anchor. Few payers anywhere pay more for a skilled nursing hour, so it is a credible reference when an agency argues that a commercial offer is below market.
For planning, watch DHCF transmittals around January, July and October, the dates on which recent home health changes took effect. The DC Medicaid rates page covers all 87,654 current DC rates, and the pricing page explains full access with source documents.
Every DC rate is compiled from official state Medicaid publications, including the DHCF medical fee schedule report and the rate transmittals named above, and each rate links to its source document. The methodology explains how 15-minute rates are converted and ranked, and the home health hub shows where every state stands.