S9128 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 S9128, 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. 5 of the 7 states list more than one rate for S9128, 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 7 states, 5 publish S9128 per day and 1 per visit, and 1 schedule prints no unit at all (a flat amount per service).
• Per hour. S9128 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 S9128, 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 S9128 run from $40.00 in Kansas to $264.78 in Utah, a 6.6x gap in the same unit. Half the states pay more than the median of $105.98 and half pay less. The usual reasons for a spread like this in home health rates:

• Some states pay home health per visit and others per 15 minutes or per hour, and Medicare pays a different way altogether.
• Rates differ by discipline: skilled nursing, home health aide, physical, occupational and speech therapy.
• Rural adjustments and add-ons for travel or high-acuity patients vary by state.

Timing matters too. 3 states set the current rate for S9128 in 2026 or later, while 2 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 S9128 is negotiated privately, but the state decides how much room there is to negotiate. Here is how the rules break down across the 7 states.

In 2 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 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.
• Plans must pay at least the published rate (1 state). 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 Utah managed care.

S9128 is a HCPCS Level II temporary national code in the home health line, billed mostly by certified home health agencies. 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.

Prior authorization often sets the number of visits that can be billed. Home health visits are billed per visit or in 15-minute units depending on the state and the code.

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.