S5110 Medicaid reimbursement rate by state (2026)

• Order. States are listed from the highest published rate to the lowest. A like-for-like rank only counts states that use the same unit: 8 of the 8 states publish S5110 per 15 min, enough to rank them against each other.
• Medicaid rate. The most the state's fee-for-service program pays for one unit, as published. 5 of the 8 states list more than one rate for S5110, by modifier, provider type or setting; the table shows the one that matches the provider level and setting used across states, without add-ons.
• Unit. All 8 states publish S5110 per 15 min, so the amounts compare directly.
• Per hour. Time-based units are converted to an hour of service (four 15-minute units make an hour). 7 of the 8 states bill S5110 by time, with a median of $31.20 per hour.
• Managed-care plans. The rule the state sets for its plans on this rate. What each rule means is explained below.
• % of Medicare. No Medicare physician fee schedule amount is on file for S5110, so there is no percentage.
• Source and date. Each Source link opens the state's own document; “since” is the date the rate took effect.

Published rates for S5110 run from $3.23 in Louisiana to $27.26 in Idaho, a 8.4x gap in the same unit. Half the states pay more than the median of $6.33 and half pay less. The usual reasons for a spread like this in private duty nursing rates:

• Group nursing, where one nurse cares for more than one patient, is paid at a reduced rate in many states.
• Nursing rates compete with hospital wages, so states facing shortages have raised them out of step with the rest of the schedule.
• Registered nurse and licensed practical nurse services carry different rates, and many states add an amount for ventilator, tracheostomy or other high-acuity care.

Timing matters too. 3 states set the current rate for S5110 in 2026 or later, while 3 states still pay a rate that took effect in 2022 or earlier. A state that has not updated its rate in years will drift down the ranking as others raise theirs.

What a plan pays for S5110 is negotiated privately, but the state decides how much room there is to negotiate. Here is how the rules break down across the 8 states.

In 3 states, the published rate binds plans: a floor, a pass-through or a state-set rate. In 2 states, plans negotiate and the published rate is a benchmark or out-of-network default. In 1 state, the service is paid outside the plans or through a state-directed payment. The rule for the remaining 2 states is not classified yet.

• Plans must pay at least the published rate (2 states). The published rate is your floor. Negotiate up from it, and if a plan pays less, the contract provision is the basis for a payment dispute.
• Plans negotiate; the published rate applies out of network (2 states). In-network rates can be above or below the published rate. The published rate is the benchmark both sides know, and the fallback if no contract is signed.
• Plans are expected to pay at least the published rate (1 state). Treat the published rate as a strong anchor, and confirm the minimum is written into your own plan agreement.
• Paid by the state, outside the plans (1 state). Bill the state's Medicaid program, not the plan, at the published rate. There is no plan contract to negotiate for this service.

Plan-negotiated rates are never estimated here. To see the rule and its citation for a particular state, open that state's managed-care page, for example Idaho managed care.

S5110 is a HCPCS Level II temporary national code in the private duty nursing line, billed mostly by home nursing agencies and independent nurses. S codes were created for private payers and are widely used by Medicaid programs for services Medicare does not cover, such as home nursing and home infusion. Units range from 15 minutes to a day.

Shift nursing is billed in 15-minute units under some codes and per hour under others, so convert to an hourly rate before comparing. Prior authorization usually sets the number of hours per week that can be billed.

Before billing, confirm the rate, unit and any modifier with the state's current schedule or the plan: the amounts here are as published, not a guarantee of payment.