Private duty nursing Medicaid rates in South Dakota are near the top of the country, and the LPN rate is the standout. South Dakota Medicaid pays $77.36 an hour on code S9124 for LPN private duty nursing, the 2nd-highest of 39 states and 75.5% above the national median. RN care pays $92.80 an hour on S9123, 6th of 43 states and 69.2% above the $54.84 national median.
Combine those rates with nurse wages well below the national median and South Dakota PDN rates leave wide margins on both nurse levels. Every rate here is compiled from official state Medicaid publications and links to its source document on the South Dakota Medicaid rates page.
South Dakota publishes its state plan PDN rates per hour, both effective 2026-07-01:
| Service | Code | Rate | Rank | vs national median |
|---|---|---|---|---|
| PDN, RN | S9123 | $92.80 an hour | 6 of 43 | +69.2% |
| PDN, LPN | S9124 | $77.36 an hour | 2 of 39 | +75.5% |
Only Massachusetts, at $90.96, pays more than South Dakota for LPN private duty nursing. For RN care, South Dakota trails Utah, Massachusetts, Georgia, Rhode Island and Hawaii.
Both rates are hourly, which keeps billing for long shifts simple: each authorized hour on shift is one unit. The hourly unit also makes it easy to compare the rate directly with payroll, which is how the margin figures below are built.
South Dakota's waiver nursing listings use T1000 with TD and TE modifiers, billed per unit of up to 15 minutes, both effective 2026-07-01: $23.20 per unit for RN care (TD) and $19.34 per unit for LPN care (TE). Because the unit is defined as "up to" a time increment rather than a fixed one, these listings are not ranked in our hourly waiver comparison.
For billing teams, the practical point is that the same T1000 code carries two different rates, separated only by modifier. The modifier must follow the credential of the nurse on the visit. Set it automatically from the nurse's record in the scheduling system rather than by hand, and review the first remittances on each new waiver case.
South Dakota's nurse wages sit well below the national median. Federal wage data for May 2025 put the state median at $37.53 an hour for registered nurses, against $46.90 nationally, and $25.36 for licensed practical nurses, against $30.96.
That produces unusually wide margins after loaded wages:
- RN private duty nursing: the loaded median RN wage is 57.5% of the $92.80 rate, leaving $39.46 an hour.
- LPN private duty nursing: the loaded median LPN wage is 46.6% of the $77.36 rate, leaving $41.32 an hour.
What the margins make possible
The LPN line leaves more per hour than the RN line. For an agency, that makes LPN staffing the stronger model wherever a patient's plan of care allows it, while still leaving the RN line well funded for high-acuity cases.
The margins also give agencies room to pay above the state median wage to recruit. In a rural state, where a nurse may drive long distances between clients and where hospitals compete for the same staff, that room matters. Agencies should decide up front how much of the margin goes to wages and travel pay, and how much is needed for supervision, training and on-call coverage.
South Dakota's record shows regular, scheduled increases for private duty nursing:
- Tracking Log entry 125: Private Duty Nursing/Extended Home Health Aide, implemented inflationary increase effective 2022-07-01; the July 1, 2022 fee schedules carry a listed change of 6.0%.
- Tracking Log entry 96: implemented inflationary increase effective 2023-07-01; the July 1, 2023 fee schedules carry a listed change of 5.0%.
- Tracking Log entry 16: implemented inflationary increase effective 2024-07-01; the July 1, 2024 fee schedules carry a listed change of 4.0%.
- DSS provider communication 2025-07-07, Medicaid Reimbursement and Care Management Referral Updates, with a listed change of 1.25%.
The pattern is a July 1 update each year. For budgeting, that predictability is valuable: agencies can plan wage adjustments around a known annual date rather than waiting on an irregular rate action, and the record shows increases rather than cuts. The current PDN rates carry the 2026-07-01 date, so they reflect the latest annual cycle.
For SFY2027, HB 1326, the General Appropriations Act, enacted discretionary provider inflation lines for several divisions, each with a listed change of 1.4%, including Long Term Services and Supports and Developmental Disabilities, alongside a mandatory inflation line for Medical Services. The DSS provider communication of 2026-07-01 on SFY27 reimbursement methodology and rate updates implemented the new cycle.
The size of the annual change has narrowed over time, from 6.0% in 2022 to smaller figures in recent cycles. Agencies should read that as a reason to budget wage growth carefully: the schedule still rises every July, but recent increases are smaller than the earlier ones, and wage growth may outpace them in some years.
An annual update brings a predictable billing task. Claims are priced by date of service, so shifts delivered on or before June 30 price at the old schedule and shifts from July 1 at the new one. Long shifts that cross midnight on the change date, and claims for a billing period that spans the change, are the most likely to price incorrectly.
A short routine each July avoids most problems. Confirm the date the new rates were loaded in the billing system, split any claim period that spans July 1, and review the first remittances after the change for every code the agency bills, including the waiver T1000 lines. If a claim priced at the old rate for a post-change date of service, correct and resubmit it promptly. Agencies that bill monthly should also confirm that payroll changes made for July 1 line up with the new revenue, so margins are measured on matching periods.
South Dakota's coverage data list one prior authorization rule each on S9123 and S9124, and two on T1000. No unit limits are listed. Authorization is light at the code level, so the main constraint on a case is the number of hours approved in the plan of care.
Intake teams should still confirm the authorization covers the credential, the hours and the dates before the first shift, and should request revisions before adding hours when a patient's needs change. On waiver cases billed on T1000, the two rules on that code apply on top of the waiver service plan.
South Dakota Medicaid is run on a fee-for-service basis by the DSS Division of Medical Services. Our records list 4 plan arrangements, all care-management and vendor programs rather than risk-based plans: PRIME primary care case management providers, Care Connect (Health Home) providers, BabyReady designated providers and a dental vendor. No managed-care rule applies to home nursing in South Dakota, and agencies bill the state schedule directly. See the South Dakota managed care page for the full list.
For a nursing agency, that is a simple model: one payer, one schedule, one annual update date. There are no plan contracts to negotiate and no plan-by-plan rate differences to reconcile.
The state's home and community-based waivers include the HOPE Waiver for elderly adults and adults with physical disabilities, the CHOICES Waiver for comprehensive developmental disability services, the Family Support 360 Waiver for in-home developmental disability supports and the Assistive Daily Living Services (ADLS) Waiver. HOPE is run by DHS Long Term Services and Supports; CHOICES and Family Support 360 by the DHS Division of Developmental Disabilities.
Each waiver has its own eligibility, case management and service plan process. An agency should know at intake whether a client's nursing hours are state plan PDN on S9123 and S9124 or waiver nursing on T1000, because the code, the unit and the rate all differ.
On LPN private duty nursing, the top five are Massachusetts ($90.96), South Dakota ($77.36), Utah ($75.10), Rhode Island ($69.32) and Montana ($63.44). The lowest are Mississippi ($14.95), New Jersey ($12.89) and Oklahoma ($8.92).
For RN care, South Dakota's $92.80 sits just behind Hawaii ($94.04), with Virginia ($25.86), New Jersey ($15.75) and Oklahoma ($8.92) at the bottom. Its neighbor North Dakota pays for home nursing mainly through waiver rates, a very different structure for agencies working across the state line.
- Lean on LPN staffing where clinically appropriate. The LPN line carries the widest margin.
- Plan around July 1. Align wage reviews and budgets with the annual fee schedule update.
- Budget for smaller increases. Recent annual changes are smaller than earlier ones.
- Separate state plan and waiver billing. Different codes, units and modifiers apply.
- Compare related lines, such as home health in South Dakota, and the national private duty nursing hub.
All South Dakota rates on this page are compiled from official South Dakota Department of Social Services publications, including the July 1 fee schedules and DSS provider communications. Each rate on the South Dakota Medicaid rates page links to its source document and effective date. National ranks compare published hourly rates for the same service and provider level; listings without a fixed time unit are not ranked. Wages are federal May 2025 state medians. Our methodology explains which listings are ranked, and all 41,546 current South Dakota Medicaid rates are available on our plans.