S5160 Medicaid reimbursement rate by state (2026)

• Order. States are listed from the highest published rate to the lowest. No single unit is shared by 8 or more states for S5160, so the order is by published amount and is not a like-for-like rank.
• Medicaid rate. The most the state's fee-for-service program pays for one unit, as published. 17 of the 27 states list more than one rate for S5160, 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. Of the 27 states, 3 publish S5160 per one time, 1 per each time, 1 per unit and 8 in other units, and 14 schedules print no unit at all (a flat amount per service).
• Per hour. S5160 is not billed in time units in these states, so no hourly figure is shown.
• 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 S5160, 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 S5160 run from $1.06 in New Mexico to $500.00 in Minnesota. The two publish it in different units (Each Time versus no unit printed), so part of that gap is the unit rather than the price. Half the states pay more than the median of $53.96 and half pay less. The usual reasons for a spread like this in other home & community services rates:

• Case management may be paid as a monthly rate, a per-contact rate or in 15-minute units.
• Home and community-based services are often paid under waivers, and each waiver can set its own rate for the same service.
• Some services are paid per 15 minutes in one state and per day or per month in another.

Timing matters too. 8 states set the current rate for S5160 in 2026 or later, while 9 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.

No managed-care plan publishes what it pays for S5160. What is public is the rule each state's plan contracts set, and that rule decides how much the published rate matters when you contract with a plan.

In 3 states, the published rate binds plans: a floor, a pass-through or a state-set rate. In 5 states, plans negotiate and the published rate is a benchmark or out-of-network default. In 8 states, the service is paid outside the plans or through a state-directed payment. The rule for the remaining 11 states is not classified yet.

• Paid by the state, outside the plans (8 states). Bill the state's Medicaid program, not the plan, at the published rate. There is no plan contract to negotiate for this service.
• Plans negotiate; the published rate applies out of network (5 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 must pay at least the published rate (3 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.

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 Minnesota managed care.

S5160 is a HCPCS Level II temporary national code in the other home & community services line, billed mostly by case management agencies, adult day centers, respite providers and other home and community-based services. 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.

Units range from 15 minutes to a day or a month, so a per-unit comparison only holds when the states use the same unit.

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.