Home health Medicaid rates in South Dakota sit almost exactly at the national middle. South Dakota Medicaid pays $23.20 per 15 minutes for a skilled nursing visit on G0299, or $92.80 an hour, ranking 8th of 14 ranked states and just 3.2% below the national median of $23.96. Physical therapy, at $30.46 per 15 minutes, is 1.1% above its national median.
What makes South Dakota distinctive is not the rates but what sits around them: low wages for most clinical roles, a schedule updated on July 1, 2026, and no prior authorization rules on the core home health codes.
All of South Dakota's home health rates in this comparison have been in effect since July 1, 2026:
| Discipline | Code | Per 15 min | Per hour | Rank | vs national median |
|---|---|---|---|---|---|
| Nurse visit | G0299 | $23.20 | $92.80 | 8 of 14 | -3.2% |
| Physical therapy | G0151 | $30.46 | $121.84 | 9 of 19 | +1.1% |
| Occupational therapy | G0152 | $30.46 | $121.84 | 8 of 18 | +3.8% |
| Speech therapy | G0153 | $24.14 | $96.56 | 11 of 16 | -18.2% |
| Aide | G0156 | $11.17 | $44.68 | not ranked | n/a |
Physical and occupational therapy share one rate. Speech therapy is paid less, and it is the only South Dakota home health discipline more than a few percent from its national median. The aide rate is priced per 15 minutes rather than per visit, so it is not placed in the national aide ranking.
Every South Dakota home health discipline is paid in 15-minute units on the standard G-codes. That makes the state's rates easy to compare and easy to forecast, but it puts weight on documentation.
Units follow documented time
A clinician bills the number of 15-minute units that match the documented time providing care in the home. A 45-minute nursing visit bills three units, a full hour four. Accurate start and stop times are the basis of every claim.
Travel and charting are unpaid
No unit is billed for driving between homes or for charting after a visit. In a large state with long distances between patients, those unpaid hours are the main threat to margin. The rate is fair for time in the home; it does nothing for time on the road.
Aides on the same footing
Unlike many states that pay aides a flat visit rate, South Dakota pays aides by the quarter hour as well. Longer aide visits earn proportionally more, which suits patients who need extended hands-on help.
A rate near the median means different things in different labor markets, and South Dakota's labor market is a low-wage one for nurses. The median registered nurse wage in South Dakota was $37.53 an hour in May 2025, against a US median of $46.90. Licensed practical nurses earned $25.36, against $30.96.
At those wages, a median RN's pay is 57.5% of the $92.80 hourly nursing rate. After a loaded wage, the margin is $39.46 per billed hour. The cushion comes as much from wages well under the national figure as from the rate itself.
The margin still has to cover what home health cannot bill: driving between patients, charting and supervision. In a largely rural state, drive time is the cost most likely to erode it, so route planning decides how much of that $39.46 an agency keeps.
Therapist wages in South Dakota are also below the national medians, most sharply for speech-language pathologists:
- Physical therapists: $44.55 an hour, against $49.40 nationally. The wage is 52.0% of the rate, leaving $58.52 per billed hour after a loaded wage.
- Occupational therapists: $40.89, against $48.24. The wage is 47.7% of the rate, leaving $63.72.
- Speech-language pathologists: $31.58, against $47.05. The wage is 46.5% of the rate, leaving $51.68.
So although South Dakota pays speech therapy 18.2% below the national median, the low local wage keeps its margin close to the other therapy disciplines. Occupational therapy has the widest margin of any South Dakota home health line, because it shares the higher therapy rate with physical therapy but carries a lower median wage.
Aides are the exception to South Dakota's low-wage pattern. The median home health aide wage of $18.15 an hour is above the US median of $17.21. Against the $44.68 hourly aide rate, that wage is 57.7%, leaving $18.88 per hour after a loaded wage.
That is still a workable spread, but it is the thinnest margin of any South Dakota discipline, and it is the line where drive time hurts most. A 30-minute aide visit that requires a 30-minute drive earns two units while paying the aide for four quarter hours. Agencies that schedule aides in tight clusters, or pair aide and nursing visits in the same home, protect this line best. Patients who need long daily aide hours may fit South Dakota's personal care benefit better; see South Dakota home care rates.
South Dakota lists no prior authorization rules and no unit limits on G0151, G0152, G0153, G0156, G0299 or G0300. For an agency, that removes one of the main administrative delays at start of care. Visits can be scheduled when the plan of care is ready, not when an approval comes back.
That simplicity is part of the value of South Dakota's rates. A median rate with no approval step can be worth more in practice than a higher rate that requires several. Intake staff time that would go to authorizations elsewhere can go to scheduling and documentation quality, both of which protect revenue directly. Physician orders and a current plan of care still underpin every claim.
South Dakota has a record of regular, predictable updates to home health rates:
- Inflationary increase effective July 1, 2024 (Tracking Log entry 20).
- Codes G0157 and G0158 added with rates effective January 1, 2024 (Tracking Log entry 62).
- Inflationary increase effective July 1, 2023 (Tracking Log entry 90).
- Inflationary increase effective July 1, 2022 (Tracking Log entry 127).
The pattern of July updates matches the July 1, 2026 effective date on the current schedule. For SFY2027, HB 1326, the General Appropriations Act, included discretionary provider inflation of 1.4% for Medical Services, effective July 1, 2026, and the Department of Social Services published its SFY27 reimbursement methodology and rate updates the same day.
Agencies planning budgets can treat July as the point when South Dakota's home health rates are most likely to move, and the appropriations act as the first signal of how much. Small, steady increases are easier to plan around than large irregular ones, but they also mean the rate will not jump to close a gap if wages rise faster.
South Dakota has no managed-care rule recorded for home health or any other service line. The arrangements counted in the state are PRIME primary care case management providers, Care Connect health home providers, BabyReady designated providers and Delta Dental of South Dakota, four in all.
Home health agencies in South Dakota Medicaid are therefore working from the published fee schedule. There is no plan contract to negotiate and no plan-specific authorization process to learn. The rate in the table is the rate paid.
The arrangements that do exist still touch home health indirectly. PRIME primary care providers coordinate care for many members and are often the source of home health orders. Care Connect health homes coordinate care for members with chronic conditions, many of whom need home health at some point. Building working relationships with those providers is the South Dakota equivalent of getting into a plan network elsewhere: it is how referrals arrive. The South Dakota managed care page shows what is recorded.
Nationally, South Dakota is a middle state on every ranked discipline. Neighboring North Dakota ranks 12th of 14 on aide visits at $20.56. Minnesota leads aide visits at $80.62, and Michigan leads physical therapy at $343.72 an hour. Nebraska, another neighbor, pays per visit rather than per unit, which makes South Dakota's time-based model the more predictable of the two for long visits.
The middle position, combined with low wages and no authorization burden, makes South Dakota a steadier home health market than its rank alone suggests.
- Budget in units. Expected visits by discipline, multiplied by average units per visit and the 15-minute rate, gives a reliable revenue forecast.
- Measure drive time. It is the cost that decides whether the margins hold, especially on the aide line.
- Lean on occupational and physical therapy. They carry the widest margins.
- Plan for July. Each July update has been modest; model it from the appropriations act.
- Use the absence of authorization. Redirect intake time to scheduling and documentation.
Every rate here is compiled from official South Dakota Medicaid publications and links to its source document. South Dakota publishes all 41,546 current Medicaid rates across 146 service categories. Rankings compare nursing and speech therapy per 15 minutes and physical and occupational therapy per hour. Wages are May 2025 medians, and margins subtract a loaded wage from the hourly rate.
See the South Dakota Medicaid rates page for the full schedule, the national home health page for every state, and our methodology for how units are converted and ranked.