Home health Medicaid rates in the District of Columbia start with the highest skilled nursing rate in the country. DC Medicaid pays $155.16 per 15 minutes for a home health nurse visit on code G0299, which is $620.64 an hour. That ranks 1st of 14 ranked states and is 547.4% above the national median of $23.96.
The rate took effect on 2026-10-01 under Transmittal 26-25, Skilled Nursing Rate Changes Effective October 1, 2026. It is billed with modifier TD. No other state comes close: Texas is second at $98.92 and Michigan third at $89.08 on G0493.
DC Medicaid home health reimbursement in 2026
DC has rates for four of the five home health disciplines in this comparison, and all four are ranked:
| Service | Code | DC rate | Per hour | Rank | vs national median |
|---|---|---|---|---|---|
| Nurse visit | G0299 (TD) | $155.16 / 15 min | $620.64 | 1 of 14 | +547.4% |
| Physical therapy | G0151 (U4) | $31.79 / 15 min | $127.16 | 8 of 19 | +5.5% |
| Occupational therapy | G0152 (U4) | $31.79 / 15 min | $127.16 | 7 of 18 | +8.3% |
| Speech therapy | G0153 (U4) | $31.79 / 15 min | $127.16 | 8 of 16 | +7.7% |
The structure is lopsided. Skilled nursing is ranked first by a wide margin, while therapy sits just above the median at a single rate of $31.79 per 15 minutes across PT, OT and speech, effective 2026-07-01.
The G0299 DC Medicaid rate and what it means for agencies
A rate of $155.16 per 15 minutes changes the economics of skilled nursing visits. The DC median wage for registered nurses in May 2025 was $49.30, slightly above the US median of $46.90. Against a $620.64 hourly rate, that wage is 11.3% of the rate, leaving $550.57 an hour after a loaded wage.
For comparison, the rest of the national nurse ranking is far lower. Delaware pays $49.07 per 15 minutes and Nevada $28.46. At the bottom are Pennsylvania ($16.55 on T1002), Maine ($16.48) and California ($15.21).
For a DC agency, the nursing rate makes skilled visits the clear anchor of a Medicaid home health business. Licensed practical nurses earn a DC median of $36.42 (US $30.96), and code G0300 also appears in the DC coverage rules.
Therapy rates in DC: G0151, G0152 and G0153
DC pays $127.16 an hour for all three therapy disciplines. That places it in the upper half without reaching the leaders:
- Physical therapy (G0151): 8th of 19, against a median of $120.52. Michigan leads at $343.72 and Utah follows at $330.48.
- Occupational therapy (G0152): 7th of 18, against a median of $117.42. Michigan pays $278.92 and New Mexico $198.64.
- Speech therapy (G0153): 8th of 16, against a median of $29.50 per 15 minutes. Missouri leads at $137.61.
The margins after a loaded wage are steady across disciplines: $57.70 an hour for physical therapy (wage 54.6% of the rate), $52.56 for occupational therapy (58.7%) and $52.41 for speech therapy (58.8%). DC therapist wages are above US medians for OT ($52.49 against $48.24) and speech ($52.59 against $47.05), and close to it for PT ($48.87 against $49.40).
Prior authorization: heavy rules on DC therapy codes
DC's coverage rules carry detailed prior authorization conditions on most home health codes:
- G0153 (speech therapy): 45 prior authorization rules.
- G0152 (occupational therapy): 30.
- G0151 (physical therapy): 22.
- G0299 (RN visit): 13.
- G0300 (LPN visit): 9.
- G0154: none.
Therapy services, especially speech, carry the most authorization conditions. An agency adding therapy in DC should expect intake and authorization staffing to be a real cost, which narrows the therapy margins above.
Recent DC home health rate changes
The District has issued a steady run of home health notices in 2025 and 2026:
- Transmittal 26-25, effective October 1, 2026: skilled nursing rate changes.
- Transmittal 26-16, effective 2026-07-01: rate notice for home health aide services.
- DC Register fee schedule updates for home health services, published 2026-05-29, alongside a proposed State Plan amendment governing reimbursement for home health services.
- Proposed rulemaking on private duty nursing reimbursement, published 2026-05-22.
- Transmittal 25-34, effective 2026-01-01: rate changes for home health aide services.
Aide rates changed twice in 2026, but no aide visit rate is on file for this comparison, so DC does not appear in the aide ranking.
Managed care and DC home health
DC has 6 plans on file, including AmeriHealth Caritas District of Columbia, MedStar Family Choice DC and Health Services for Children with Special Needs. No managed-care rule is classified for home health in DC, so the published DHCF fee schedule is the reference rate when negotiating with plans. See the DC managed-care page for plan-by-plan detail and the DC Medicaid rates page for the full schedule.
Every DC rate is compiled from official state Medicaid publications and links to its source document. The methodology explains how 15-minute rates are converted and ranked, and the home health hub shows where every state stands.
Updated 2026-10-05