Kentucky Medicaid private duty nursing rates are shaped as much by recent policy as by the fee schedule itself. On the waiver side, Kentucky pays $15.99 per 15 minutes for RN nursing, or $63.96 an hour, rank 26 of 41 states and 17.6% below the national median of $77.60. The LPN waiver rate is $46.32 an hour, rank 20 of 34 and 17.9% below the median.
Around those rates sit three developments private duty nursing agencies in Kentucky track closely: a CMS-approved directed payment for private duty nursing (KY24001), a 2024 DMS private duty nursing public notice, and a 2026 budget letter announcing a 4.0% reduction that a later update reversed.
Kentucky's waiver nursing rates are keyed to revenue codes rather than HCPCS codes: 552 for RN care and 559 for LPN care. Both took effect January 1, 2025.
| Service | Code | Per 15 min | Per hour | Rank | vs median |
|---|---|---|---|---|---|
| Waiver nursing, RN | 552 | $15.99 | $63.96 | 26 of 41 | -17.6% |
| Waiver nursing, LPN | 559 | $11.58 | $46.32 | 20 of 34 | -17.9% |
The two lines sit almost the same distance below their national medians, so Kentucky is a consistent lower-middle payer for waiver nursing at both skill levels.
Most states bill waiver nursing on HCPCS codes such as T1002 and T1003. Kentucky uses revenue codes 552 and 559 instead, priced per 15 minutes. Four units make an hour, so the $15.99 RN unit becomes $63.96 and the $11.58 LPN unit becomes $46.32.
For agencies new to Kentucky, the coding difference is the first operational hurdle. Claims built on a HCPCS template from another state will not price correctly. Billing staff should set up separate claim templates for revenue-code waiver nursing and for any HCPCS-coded services the agency also provides.
On the state plan side, Kentucky publishes its private duty nursing line per unit on code T4526, at $0.78 per unit, effective January 1, 2023. Because it is published per unit rather than per hour or per 15 minutes, it is not ranked against other states' hourly private duty nursing rates. Agencies billing it should read the state's unit definition alongside the rate on the Kentucky Medicaid rates page.
The waivers that carry nursing hours include Supports for Community Living (SCL), the Home and Community Based (HCB) waiver, the Acquired Brain Injury waivers for acute and long-term care, the Michelle P. waiver and Model Waiver II, which serves people who are ventilator-dependent. Kentucky also publishes a children's HCBS rate schedule with the HA modifier.
For private duty nursing agencies, Model Waiver II is the program most directly tied to continuous skilled nursing at home, since ventilator-dependent participants typically need long daily shifts. The Michelle P. and SCL waivers serve people with intellectual and developmental disabilities, where nursing is more often intermittent. Knowing which waiver authorized a case tells an agency what kind of staffing pattern to expect.
Four Kentucky notices bear directly on private duty nursing payment:
- DMS public notice: Private Duty Nursing Public Notice, published January 31, 2024, proposed effective February 1, 2024.
- SPA/directed payment: KY24001 Private Duty Nursing, approved by CMS, published April 12, 2024 and effective February 1, 2024.
- DMS provider letter: Medicaid Budget Impact on Provider Reimbursement, published June 8, 2026, enacting a 4.0% reduction effective August 1, 2026.
- DMS provider letter: Medicaid Budget Impact on Provider Reimbursement: Update, published July 23, 2026, recorded as reversing that 4.0% reduction.
The directed payment is the most significant item for agencies paid through managed care. A state directed payment instructs plans to pay in a specified way for a service, so a private duty nursing directed payment means plan payment for those services is not left purely to negotiation.
In practice, agencies should confirm that their plan contracts and remittances reflect KY24001. When a directed payment exists, plans sometimes pay it as a separate add-on rather than inside the base rate, so an agency reconciling payments should look for both components. If a plan's payments do not reflect the directed payment, the agency has a specific, documented basis to raise the issue.
The budget letters show how quickly the outlook changed in 2026: a cut announced in June, scheduled for August, then reversed in July. Agencies that adjusted staffing plans to the June letter should check that their remittances reflect the update.
The episode is a useful planning lesson. A rate reduction announced by provider letter can arrive with less than two months' notice, and a reversal can follow just as quickly. Agencies with thin margins benefit from keeping a short-term reserve and from modeling a downside case, so a sudden change does not force staffing cuts that are hard to undo.
Kentucky nurse wages sit below the national level. The state median is $38.96 an hour for registered nurses, against $46.90 nationally, and $29.07 for licensed practical nurses, against $30.96.
Those lower wages give the waiver rates room:
- RN waiver nursing (552): the loaded median RN wage equals 86.6% of the $63.96 rate, leaving $8.59 an hour.
- LPN waiver nursing (559): the loaded LPN wage equals 89.2% of the $46.32 rate, leaving $5.00 an hour.
Both margins are positive but modest. The RN line leaves more per hour, so Kentucky's rate structure does not push agencies toward LPN staffing the way it does in states with a narrow RN-LPN rate gap. That frees agencies to staff by clinical need, though the margin on either line leaves little room for travel time, overtime or unfilled shifts.
Kentucky lists prior authorization rules across a wide set of nursing codes: 2 each on revenue codes 552 and 559, 1 on revenue code 410, 1 each on T1000 and T1004, and 3 each on T4521, T4522, T4523 and T4526. Agencies should verify authorization for each code they bill, not only the primary nursing line.
A simple routine prevents most denials: confirm the authorized code and units before staffing, track units used against units authorized weekly, and renew authorizations before they lapse.
Kentucky's managed-care rule for private duty nursing and home health is that plans negotiate their own rates, with the published rate applying out of network. Home and community-based services and personal care, by contrast, are paid directly by the state, outside managed care, so waiver nursing on revenue codes 552 and 559 follows the published rates.
That split matters. A waiver nursing hour is paid at the published rate; a state plan private duty nursing hour paid through a plan is paid at a negotiated rate, shaped by the KY24001 directed payment. We track 15 plans in Kentucky, including several PACE organizations such as Bluegrass Care Navigators and Horizon PACE; the Kentucky managed-care page lists each plan and rule.
On RN waiver nursing, Georgia leads at $146.72 an hour, followed by Vermont at $125.84 and Maryland at $123.08. The lowest are North Carolina at $34.88, Florida at $32.64 and Arkansas at $19.08. Kentucky's $63.96 sits between those groups.
On LPN waiver nursing, Utah leads at $345.48, then Maryland at $123.08 and Vermont at $104.12, while California pays $24.72, North Carolina $13.92 and Arkansas $12.68. Kentucky's $46.32 is comfortably above that bottom group. Neighboring Mississippi is a useful comparison for agencies operating in the region.
Kentucky's mix of revenue codes, waivers and managed-care rules makes intake checks especially useful:
- Which program authorized the hours? Waiver nursing on 552 and 559 is paid by the state; state plan private duty nursing through a plan is negotiated.
- Which waiver is it? Model Waiver II, SCL, Michelle P., HCB and the ABI waivers carry different staffing patterns.
- Which codes are authorized? Prior authorization rules sit on several codes, not just the primary nursing line.
- Is the member in a managed-care plan? If so, confirm the contracted rate and how the KY24001 directed payment is reflected.
Answering these before the first shift reduces denials, sets realistic staffing expectations, and gives the agency a clear record of which programs and plans pay reliably.
Rates on this page are compiled from official state Medicaid publications, and every rate links to its source document. For Kentucky, sources include DMS fee schedules, DMS provider letters and the KY24001 directed payment approval. The Kentucky Medicaid rates page lists all 39,971 current Kentucky rates across 11 programs.
Rankings compare each state's rate per hour for the same service and provider level. The private duty nursing rates by state overview ranks every state, our methodology explains how 15-minute units become hourly figures, and pricing covers full access to rate history and sources.