Private duty nursing Medicaid rates in South Carolina sit just below the national middle after a recent round of increases. South Carolina Healthy Connections Medicaid pays $47.00 an hour on code S9123 for RN private duty nursing, effective since 2025-11-01. That ranks 28th of 43 states and sits 14.3% below the $54.84 national median.
South Carolina's record shows a deliberate push on home-based private duty nursing: a final rate increase, a CMS-approved state plan amendment and a broader HCBS rate update, all from 2024. Every rate here is compiled from official state Medicaid publications and links to its source document on the South Carolina Medicaid rates page.
South Carolina publishes its RN private duty nursing rate per hour on S9123: $47.00 an hour, rank 28 of 43, 14.3% below the national median. The hourly unit makes the rate straightforward to compare with nurse wages and with other states.
LPN private duty nursing is listed on T1000, a listing in effect since 2017-07-01. That listing is not ranked in our hourly LPN comparison, so South Carolina does not appear among the ranked LPN states on the private duty nursing hub. Agencies staffing LPN shifts should read the T1000 listing and its unit on the source document linked from the state page before setting up claims.
| Service | Code | Rate | Rank | vs national median |
|---|---|---|---|---|
| PDN, RN | S9123 | $47.00 an hour | 28 of 43 | -14.3% |
| Waiver nursing, RN | T1002 | $12.50 per 15 min ($50.00 an hour) | 32 of 41 | -35.6% |
South Carolina uses two different units for its RN nursing lines: an hourly rate for state plan PDN and a 15-minute rate for waiver nursing. The two convert to similar hourly figures, $47.00 and $50.00, but they are billed differently.
For the hourly state plan line, each authorized hour on shift is one unit. For the waiver line, each hour is four units, and partial hours are billed in quarter-hour increments. Agencies running both should keep separate claim templates and agree a rounding rule for partial waiver units at the start and end of each visit. Mixing the two, for example billing a waiver hour as one unit, is a common source of underpayment.
South Carolina's recent record is concentrated on this service line:
- Public Notice of Final Action for Home-Based Private Duty Nursing Rate Increase, published 2024-06-25, with a listed change of 11.51%.
- Rate Updates for Home and Community-based Services and State Plan Services, published 2024-06-20 and effective 2024-07-01, with a listed change of 11.9%.
- SC SPA 24-0019, approved by CMS on 2024-11-06 with an effective date of 2024-07-01, which updates the rate for home-based private duty nursing.
The current RN rate and the RN waiver rate both carry a 2025-11-01 effective date, after these 2024 actions. For agencies, the direction of travel matters: South Carolina has raised PDN rates more than once in a short period, a pattern worth factoring into multi-year planning.
What to watch next
The FY 2026-27 Appropriations Act (H.5126) includes Part IB proviso 33.30, a DHHS local provider rate review, effective 2026-07-01. A legislated rate review is often where the next home-based rate change starts. South Carolina has also published proposed waiver renewals for the Intellectual Disability/Related Disabilities (ID/RD) and Medically Complex Children (MCC) waivers, both relevant to in-home nursing.
South Carolina nurse wages sit below the national median. Federal wage data for May 2025 put the state median at $39.60 an hour for registered nurses (US: $46.90) and $29.72 for licensed practical nurses (US: $30.96).
Even with lower wages, the RN lines are tight:
- RN private duty nursing: the loaded median RN wage is 119.7% of the $47.00 rate, so the line runs at a loss at the median wage.
- RN waiver nursing: the loaded median RN wage is 112.6% of the $50.00 waiver rate, also a loss.
For RN-staffed cases, South Carolina agencies need wages below the state median, or other revenue, to make a shift break even. Even after the 2024 increases, the loaded cost of a median-wage RN still exceeds both RN rates.
Staffing implications
That gap makes credential mix a central decision. Where a patient's plan of care allows LPN staffing, agencies should understand how the T1000 LPN listing prices their shifts before deciding the mix. Where RN care is required, such as ventilator-dependent patients, agencies should plan those cases as part of a broader caseload rather than as stand-alone business, and keep supervision and travel costs tightly managed.
South Carolina's waiver nursing rate for RNs is $12.50 per 15 minutes on T1002, or $50.00 an hour, ranking 32nd of 41 states, 35.6% below the $77.60 median. Our data do not include a South Carolina LPN waiver nursing rate.
The state's waiver programs relevant to in-home nursing include the Medically Complex Children (MCC) Waiver and the Community Long Term Care waivers (Community Choices, HIV/AIDS and Mechanical Ventilator Dependent). DDSN operates the ID/RD, Head and Spinal Cord Injury (HASCI) and Community Supports waivers. Agencies serving ventilator-dependent adults or medically complex children should match each case to its program before scheduling, since the waiver and state plan rates differ.
Our coverage data do not list prior authorization rules or unit limits on South Carolina's private duty nursing codes. That keeps code-level billing simple, but the hours on each case still come from the plan of care or the waiver service plan.
Intake teams should confirm three things before staffing a new case: which program funds the hours, the number of hours approved per day or week, and the credential the plan of care requires. With no code-level prior authorization to act as a check, the agency's own intake routine is what keeps delivered hours aligned with what will be paid.
South Carolina runs Healthy Connections Medicaid fee-for-service and Healthy Connections Medicaid Managed Care with five statewide MCOs. Our records list 13 plan arrangements, including Absolute Total Care, Healthy Blue by BlueChoice HealthPlan SC, Humana Healthy Horizons in South Carolina, Molina Healthcare of South Carolina and Select Health of South Carolina (First Choice), as well as several PACE programs.
For private duty nursing, the rule on file is that it is paid directly by the state, outside managed care. Home and community-based services, personal care and intellectual and developmental disability services follow the same rule. For a nursing agency, that means the published S9123, T1000 and T1002 rates are the rates; there is no plan contract to negotiate, and rate improvements come only through state action. The South Carolina managed care page lists each rule.
For RN private duty nursing, Utah pays $254.03 an hour, Massachusetts $130.64, Georgia $95.36, Rhode Island $94.40 and Hawaii $94.04. At the bottom, Virginia pays $25.86, New Jersey $15.75 and Oklahoma $8.92. South Carolina's $47.00 sits in the middle band.
On RN waiver nursing, South Carolina's $50.00 sits above the bottom three, North Carolina ($34.88), Florida ($32.64) and Arkansas ($19.08), but well below leaders such as Georgia ($146.72). For agencies near the state lines, North Carolina and Georgia are the obvious comparisons, and they differ sharply on both lines.
A middle ranking with below-median wages is a common pattern in the South Atlantic region, and it produces a specific kind of market. Rates are high enough to attract agencies, but not high enough for RN-heavy caseloads to cover their costs at median pay. The agencies that do well in such a market tend to be the ones that manage credential mix, scheduling density and travel closely, rather than those that rely on the rate alone.
South Carolina's nursing rates carry several effective dates: 2017-07-01 for the LPN T1000 listing, 2024-07-01 for the home-based PDN increase under SC SPA 24-0019, and 2025-11-01 for the current RN state plan and waiver rates. Claims are priced by date of service, so any rebilling of older shifts must use the rate in force on the date the care was given.
The dates also tell a planning story. The RN lines have moved recently; the LPN listing has not been reset since 2017. Agencies with LPN-heavy caseloads should not assume the next rate action will cover their line, and should watch the local provider rate review for any reference to LPN nursing.
- Know the unit for each line. State plan RN is hourly; waiver RN is per 15 minutes.
- Plan RN cases as part of a mix. Neither RN line covers a median-wage RN on its own.
- Follow the rate review. The proviso 33.30 local provider rate review and the waiver renewals are the next likely sources of change.
- Expect state payment. Private duty nursing is paid outside managed care, so the published rate is the rate.
- Compare related lines, such as home care in South Carolina, before expanding services.
All South Carolina rates on this page are compiled from official South Carolina Department of Health and Human Services publications, including the Healthy Connections fee schedules, public notices of final action and SC SPA 24-0019. Each rate on the South Carolina Medicaid rates page links to its source document and effective date. Per-hour figures convert 15-minute units to an hour, national ranks compare published rates for the same service and provider level, and wages are federal May 2025 state medians. Our methodology explains how hourly rates are compared, and all 177,358 current South Carolina Medicaid rates are available on our plans.