Private duty nursing Medicaid reimbursement rates by state are among the most consequential numbers in home-based care, because nearly all of the rate goes to one nurse's wage. The national median for RN private duty nursing is $54.84 an hour across 44 states. Utah pays $254.03 an hour on code S9123, while Oklahoma pays $8.92 on T1000.
Private duty nursing serves medically complex children and adults in long shifts at home. For an agency, the gap between the hourly rate and a nurse's hourly wage is the entire business. We track 4,139 current private duty nursing rates across 50 states, compiled from official state Medicaid publications with a link to each source document.
| Service | States | National median | Highest | Lowest |
|---|---|---|---|---|
| Private duty nursing, RN | 44 | $54.84 | Utah $254.03 | Oklahoma $8.92 |
| Private duty nursing, LPN | 42 | $44.08 | Massachusetts $90.96 | Oklahoma $8.92 |
| Waiver nursing, RN | 46 | $77.60 | Georgia $146.72 | Arkansas $19.08 |
| Waiver nursing, LPN | 40 | $56.42 | Utah $345.48 | Arkansas $12.68 |
Waiver nursing pays more than state plan private duty nursing at both levels, and the waiver ranking has a different set of leaders. Vermont and Maryland, absent from the top of the private duty lists, are both in the top three for RN waiver nursing. Utah is the one state that appears near the top of all four lists.
Private duty nursing is continuous, shift-based skilled care, which makes its billing simpler than most home services but also less forgiving.
Codes by nurse level
The common codes split by license: S9123 and T1002 for RN care, S9124 and T1003 for LPN care, and T1000 where a state uses one code for private duty nursing generally. Some states use T1000 for both levels at the same rate.
Units
States publish rates per hour or per 15-minute unit. All figures on this page are converted to an hourly basis so states compare directly.
Programs and modifiers
The same shift can be paid under the state plan benefit or under a waiver, and states may add modifiers for multiple patients in one home, nights or weekends, or pediatric care. The base hourly rate is the starting point, not the full picture.
The states that consistently pay well for private duty nursing are a small group.
- Utah pays $254.03 an hour for RN private duty nursing, $75.10 for LPN, $120.00 for RN waiver nursing and $345.48 for LPN waiver nursing. It appears in the top five on all four services.
- Massachusetts pays $130.64 for RN care on T1002, second only to Utah, and leads LPN private duty nursing at $90.96 on T1003.
- Georgia pays $95.36 on S9123 and leads RN waiver nursing at $146.72 on T1002.
- Rhode Island pays $94.40 (RN) and $69.32 (LPN), both on T1000.
- Vermont and Maryland appear only on the waiver side: Vermont at $125.84 (RN) and $104.12 (LPN), Maryland at $123.08 for both.
Hawaii ($94.04 on S9123) completes the RN top five, and South Dakota ($77.36 on S9124) is second for LPN care, ahead of Utah.
The bottom of the private duty nursing ranking is where agencies struggle to staff cases at all.
- Oklahoma is lowest on both RN and LPN private duty nursing at $8.92 an hour on T1000.
- New Jersey pays $15.75 for RN and $12.89 for LPN care on S9123 and S9124, second-lowest on both state plan lines.
- Virginia pays $25.86 for RN care, and Mississippi $14.95 for LPN care.
- Arkansas is lowest on both waiver lines, at $19.08 (RN) and $12.68 (LPN). North Carolina and Florida are also near the bottom on waiver nursing.
RN private duty nursing is ranked in 43 states, which makes it the clearest basis for tiers.
Top quartile
Utah, Massachusetts, Georgia, Rhode Island and Hawaii lead, with South Dakota, Montana and Iowa close behind. Rates in this tier clear the median RN wage by a wide margin, so agencies can recruit experienced pediatric nurses, pay shift differentials and staff hard-to-fill night hours.
Middle half
Most states cluster around the $54.84 median, which Maryland pays exactly. Arizona, Nevada, Delaware, Colorado and North Carolina sit nearby. Here, an RN shift barely covers the wage and its taxes, so agencies tend to rely on LPN staffing wherever a care plan allows.
Bottom quartile
The lowest tier includes Florida and New York and ends with Virginia, New Jersey and Oklahoma. Rates here sit below the median RN wage, so authorized hours are hard to staff at the rate, and agencies in these states must lean on LPN shifts or other payers to keep cases covered.
- West. The strongest region at the top. Utah leads the country, and Hawaii, Montana and Idaho are all upper-tier. California sits below the median.
- Northeast. Split. Massachusetts, Rhode Island and New Hampshire pay well, while New York, Maine and New Jersey are in the bottom tier.
- Midwest. South Dakota, Iowa, Michigan and Ohio are above the median; Wisconsin, Nebraska, Illinois and Kansas sit in the lower tier.
- South. Georgia is the clear leader, and Louisiana and Delaware sit above the median. Florida, Mississippi, Arkansas, Virginia and Oklahoma are near the bottom.
Neighboring states can sit in opposite tiers. Massachusetts and New York, or Georgia and Florida, pay very different RN rates for the same shift, which matters for agencies that recruit nurses across state lines.
At the national level, the RN and LPN rate tiers sit close together. The state plan medians are $54.84 for RNs and $44.08 for LPNs, while waiver nursing shows a wider gap at $77.60 and $56.42.
That narrow state plan gap shapes staffing. Where an LPN rate sits close to the RN rate, LPN shifts carry better margins, because the LPN's wage is much lower than the RN's. Rhode Island ($94.40 RN, $69.32 LPN) and Massachusetts ($130.64 RN, $90.96 LPN) keep a meaningful premium for RN time, while Oklahoma pays the same $8.92 for both levels, giving agencies no rate reason to staff an RN.
Our data include state plan private duty nursing rates from 44 states and waiver nursing rates from 46 states. The waiver side pays more at the median: $77.60 against $54.84 for RN care. Waiver nursing is billed mostly under T1002 (RN) and T1003 (LPN), while state plan private duty nursing uses S9123, S9124 and T1000 more often.
For an agency, the practical question is which program a patient is enrolled in. The same nurse delivering the same shift may be paid very differently depending on whether the hours fall under the waiver or the state plan. Intake teams should confirm the program before accepting a case, not after the first claim.
Federal occupational wage data for May 2025 puts the national median wage at $46.90 an hour for registered nurses and $30.96 for licensed practical nurses.
Those numbers make the private duty nursing economics unusually transparent. At the national RN median of $54.84, an agency paying the median RN wage of $46.90 has a thin margin left for payroll taxes, benefits, nurse supervision, scheduling and on-call coverage. The LPN side is more workable: a $44.08 median rate against a $30.96 median wage leaves a wider cushion, which makes LPN staffing the more forgiving model wherever a patient's care plan allows it.
Below the wage line, the rate cannot pay a nurse at all. Oklahoma's $8.92, New Jersey's $15.75 and $12.89, and Mississippi's $14.95 all sit under the median wage for the level they pay. In Utah, Massachusetts and Georgia, rates clear the wage line with room to recruit.
In states that enroll children with complex needs in managed-care plans, private duty nursing hours are authorized and paid by the plan. The plan's rate may follow the state schedule or be negotiated, and authorization rules often matter as much as the rate: a plan that approves fewer hours, or approves them late, reduces revenue and staffing stability.
Before contracting, confirm whether plans must pay at least the state rate, how they handle modifiers for nights, weekends or multiple patients, and how quickly they pay. Each state's managed-care rules describe how plans may pay.
- Start from the wage. Compare the hourly rate with your loaded nurse cost, including taxes, benefits and differentials, at each license level.
- Confirm the program. Waiver and state plan hours can pay very differently for the same shift.
- Use the RN-LPN gap. Where care plans allow, staff LPNs in states with a narrow gap and RNs where the state pays a real premium.
- Benchmark plan offers. Compare managed-care offers with the state rate and the national median before accepting cases.
All 4,139 private duty nursing rates, with codes, modifiers and source documents, are available through our pricing plans.
Every rate on this page is compiled from official state Medicaid publications, including state plan private duty nursing schedules and waiver rate tables, and each figure links to the source document it came from. Rates are converted to an hourly basis, and rates published on a general code such as T1000 are labeled with that code. Wage comparisons use national occupational wage data for May 2025. Our methodology explains how rates are converted to hourly figures and how states are ranked.