Private duty nursing Medicaid rates in Utah top the national ranking. Utah Medicaid lists $254.03 an hour on code S9123 for RN private duty nursing, effective 2026-07-01, which ranks 1st of 43 states and sits 363.2% above the $54.84 national median. Utah also ranks 1st of 34 states for LPN waiver nursing and appears in the top five on all four nursing lines we compare.
That breadth, across RN and LPN care and across state plan and waiver programs, makes Utah the standout state for in-home nursing rates. Every rate here is compiled from official state Medicaid publications and links to its source document on the Utah Medicaid rates page.
Utah publishes state plan private duty nursing per hour:
- RN private duty nursing, S9123 with a TN modifier: $254.03 an hour, effective 2026-07-01. Rank 1 of 43, 363.2% above the national median.
- LPN private duty nursing, S9124: $75.10 an hour, in effect since 2008-10-01. Rank 3 of 39, 70.4% above the $44.08 median.
The two rates have very different histories. The RN listing carries a 2026 effective date, while the LPN rate has held since 2008. Only Massachusetts ($90.96) and South Dakota ($77.36) pay more for LPN private duty nursing.
For an agency, the hourly unit keeps billing simple: a long pediatric or adult shift is billed in hours, and the rate compares directly with hourly payroll. The RN listing's TN modifier and 2026 effective date identify it in the source document linked from the state page, and the gap between the RN and LPN rates gives Utah a large premium for RN time.
Matching the listing on each claim
Because the RN rate is tied to the TN modifier, the modifier must appear on every RN shift for the claim to match the listing. Set it automatically from the nurse's credential rather than by hand. The LPN rate on S9124 has no modifier in the listing, so adding one by habit from another state's setup can cause a mismatch. Review the first remittances on each new case to confirm pricing.
| Service | Code | Rate | Per hour | Rank | vs median |
|---|---|---|---|---|---|
| PDN, RN | S9123 TN | $254.03 an hour | $254.03 | 1 of 43 | +363.2% |
| PDN, LPN | S9124 | $75.10 an hour | $75.10 | 3 of 39 | +70.4% |
| Waiver nursing, RN | T1002 | $30.00 per 15 min | $120.00 | 4 of 41 | +54.6% |
| Waiver nursing, LPN | T1003 | $86.37 per 15 min | $345.48 | 1 of 34 | +512.3% |
RN waiver nursing has paid $30.00 per 15 minutes since 2017-04-01, behind only Georgia, Vermont and Maryland. LPN waiver nursing has been listed at $86.37 per 15 minutes since 2012-07-01, the top LPN waiver figure in our data.
Waiver nursing is billed in quarter-hour units, unlike the hourly state plan codes. Agencies running both should keep separate claim templates, bill four units per waiver hour, and agree a rounding rule for partial units at the start and end of each visit.
Utah's home-based waivers include the Community Supports waiver, the Community Transitions waiver, the Aging waiver, the New Choices waiver, the Acquired Brain Injury waiver, the Limited Supports waiver and the Physical Disabilities waiver. Two others are closely tied to skilled home nursing: the Technology Dependent waiver and the Medically Complex Children's waiver. The Division of Services for People with Disabilities (DSPD) also publishes its own rate schedule of service codes.
Each waiver has its own eligibility rules, service plan process and provider enrollment. For a nursing agency, the waiver a person is enrolled in determines whether nursing hours are billed on T1002 and T1003 and how many hours the service plan allows. The Technology Dependent and Medically Complex Children's waivers are the natural starting points for agencies that specialize in ventilator, tracheostomy and other high-acuity care.
Utah's nurse wages sit below the national median. Federal wage data for May 2025 put the state median at $40.67 an hour for registered nurses (US: $46.90) and $30.40 for licensed practical nurses (US: $30.96).
Against those wages, every Utah nursing line leaves a wide margin after loaded wages:
- RN private duty nursing: loaded wage share 22.8%, margin $196.23 an hour.
- LPN private duty nursing: loaded wage share 57.5%, margin $31.89 an hour.
- RN waiver nursing: loaded wage share 48.2%, margin $62.20 an hour.
- LPN waiver nursing: loaded wage share 12.5%, margin $302.27 an hour.
Using the headroom well
Even the LPN state plan line, the narrowest of the four, leaves $31.89 an hour. That headroom lets Utah agencies pay above-market wages to recruit nurses for complex pediatric and adult cases. In a market where every line covers loaded cost, the constraint shifts from rate to staffing: the agencies that grow are the ones that can recruit, train and retain nurses for long home-based shifts. Spending part of the margin on recruitment pay, training for high-acuity care and reliable supervision is how that constraint is managed.
Utah's coverage data list prior authorization rules on every nursing code we track:
- 3 rules on T1000.
- 2 rules on S9123.
- One rule each on S9124, T1002 and T1003.
No unit limits are listed. With rates this high, authorization is where the payer controls volume, so agencies should expect the approved hours on each case to be the binding constraint. Intake should confirm that each authorization covers the credential, hours and date range before staffing, and request revisions before adding hours.
Utah Medicaid runs a fee-for-service Traditional plan and a Non-Traditional plan alongside managed care. Our records list 27 plan arrangements, including Healthy U, Health Choice Utah, Molina Healthcare of Utah, SelectHealth Community Care and Healthy Outcomes Medical Excellence (HOME), plus a network of behavioral health plans.
Utah's managed-care rules split by service line:
- Private duty nursing and home health: plans negotiate; the published rate applies out of network.
- Home and community-based services and personal care: paid directly by the state, outside managed care.
- Intellectual and developmental disability services: paid directly by the state, outside managed care.
Waiver nursing therefore follows the state's published rates. For state plan PDN, the plan contract sets the in-network rate, and the published figure is the out-of-network reference. With the published RN rate at the top of the country, agencies should know what each plan pays relative to it before signing, since a negotiated rate can sit well below the published one. The Utah managed care page lists each rule.
The four rates carry four different effective dates: 2026-07-01 for RN PDN, 2008-10-01 for LPN PDN, 2017-04-01 for RN waiver nursing and 2012-07-01 for LPN waiver nursing. Claims are priced by date of service, so any rebilling or audit must use the rate in force when the care was given.
The spread of dates also tells agencies where change is most likely. The RN state plan rate has been updated recently; the other three have held for years. Utah's Medicaid Information Bulletins, issued monthly, are where updates appear, and agencies should check each issue for nursing codes.
On RN private duty nursing, Utah's $254.03 leads Massachusetts ($130.64), Georgia ($95.36), Rhode Island ($94.40) and Hawaii ($94.04). The lowest are Virginia ($25.86), New Jersey ($15.75) and Oklahoma ($8.92).
On LPN waiver nursing, Utah's $345.48 leads Maryland ($123.08), Vermont ($104.12), Georgia ($97.44) and Connecticut ($96.32). For regional comparisons, see Nevada and New Mexico private duty nursing rates.
A first-place ranking is a strong signal, but agencies weighing a Utah expansion should read it alongside three practical questions. First, which payer will fund most of the hours: state plan PDN for plan members is paid at negotiated rates, so the published RN figure is a ceiling on what a plan is likely to offer rather than a guarantee. Second, how many waiver participants in the target area are approved for nursing, since waiver volume depends on enrollment and service plans. Third, whether the agency can recruit enough nurses, because high rates attract competitors for the same workforce. Answering those questions turns a ranking into a realistic revenue plan.
- Know the payer on each case. State plan PDN for plan members is paid at the negotiated rate; waiver nursing at the state rate.
- Invest in recruitment. Every line covers loaded cost; staffing is the constraint on growth.
- Bill each line in its own unit. Hours for S9123 and S9124, quarter-hours for T1002 and T1003.
- Watch the monthly bulletins for changes to the older rates, especially the LPN state plan rate that has held since 2008.
- Compare related lines, such as home care in Utah, and the national private duty nursing hub.
All Utah rates on this page are compiled from official Utah Medicaid publications, including the fee-for-service fee schedules, DSPD rate schedule and Medicaid Information Bulletins. Each rate on the Utah 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 rates are ranked, and all 44,888 current Utah Medicaid rates are available on our plans.