Private duty nursing Medicaid rates in Montana are among the strongest in the country on the state plan side. Montana Medicaid pays $21.86 per 15 minutes on code S9123, or $87.44 an hour for RN private duty nursing, which ranks 7th of 43 states and sits 59.4% above the $54.84 national median. The LPN rate is even higher in relative terms: $63.44 an hour on S9124, 5th of 39 states.
What makes Montana unusual is the order of its two nursing tracks. In most states waiver nursing pays more than state plan private duty nursing. In Montana the state plan rates are the stronger ones, while waiver nursing lands close to the national middle. Every rate below is compiled from official state Medicaid publications, and each one links to its source document on the Montana Medicaid rates page.
Montana publishes its private duty nursing rates in 15-minute units with a UA modifier, effective since July 1, 2025:
- RN private duty nursing, S9123: $21.86 per 15 minutes, $87.44 an hour. Rank 7 of 43, 59.4% above the national median.
- LPN private duty nursing, S9124: $15.86 per 15 minutes, $63.44 an hour. Rank 5 of 39, 43.9% above the $44.08 national median.
The LPN rate is the one that puts Montana in the national top five; among the highest-paying states for LPN private duty nursing, only Massachusetts, South Dakota, Utah and Rhode Island pay more.
For a pediatric or adult PDN agency, the RN figure means a 12-hour shift is billed as a run of 15-minute units at a rate well above what most states pay. Four units make an hour, so the $21.86 RN unit becomes $87.44 and the $15.86 LPN unit becomes $63.44.
Billing in quarter-hour units matters operationally. Visits that run short of a full hour are paid for the units actually documented, so scheduling and time records drive revenue directly. Agencies should capture start and stop times to the minute and reconcile units billed against units scheduled each week.
Montana also publishes waiver nursing rates on T1002 and T1003, with a TU modifier and the same July 1, 2025 effective date.
| Service | Code | Montana per hour | Rank | vs national median |
|---|---|---|---|---|
| Private duty nursing, RN | S9123 | $87.44 | 7 of 43 | +59.4% |
| Private duty nursing, LPN | S9124 | $63.44 | 5 of 39 | +43.9% |
| Waiver nursing, RN | T1002 | $79.52 | 18 of 41 | +2.5% |
| Waiver nursing, LPN | T1003 | $58.16 | 16 of 34 | +3.1% |
Waiver nursing pays $19.88 per 15 minutes for RNs and $14.54 for LPNs. Both sit just above the national medians of $77.60 and $56.42.
The practical point for an agency is that the same nurse can earn the agency more per hour under the state plan PDN benefit than under waiver nursing. That reverses the national pattern described on the private duty nursing hub, where waiver nursing carries the higher median.
Montana's home and community-based waivers include the Montana Big Sky Waiver for elderly and physically disabled adults, the Developmental Disabilities Program 0208 Comprehensive Waiver and a waiver for adults with severe disabling mental illness. Personal care runs through Community First Choice and Personal Care Services. State plan private duty nursing sits under Montana Medicaid and HMK Plus.
For agencies, the program matters for intake: state plan cases are approved against a plan of care, while waiver cases are tied to an individual service plan managed by the waiver. Montana issued a draft DD Rates and Billing Manual with proposed SFY2027 waiver rates effective July 1, 2026, which agencies serving DDP participants should review for any nursing-related changes.
Montana's nurse wages run below the national level, which widens margins further. Federal wage data for May 2025 put the Montana median at $41.00 an hour for registered nurses, against $46.90 nationally, and $29.91 for licensed practical nurses, against $30.96.
Against those wages, every Montana nursing line clears payroll:
- RN private duty nursing: the loaded median RN wage is 66.6% of the rate, leaving $29.17 an hour.
- LPN private duty nursing: the loaded median LPN wage is 67.0% of the rate, leaving $20.93 an hour.
- RN waiver nursing: loaded wage share 73.3%, margin $21.25 an hour.
- LPN waiver nursing: loaded wage share 73.1%, margin $15.65 an hour.
The RN state plan line has the widest cushion. That margin has to fund scheduling, clinical supervision, travel, training for complex pediatric cases and on-call coverage, but it gives Montana agencies room to raise wages to recruit that agencies in low-paying states do not have.
Because RN and LPN shares of the rate are nearly identical, the rate structure does not push agencies toward either level. Staffing can follow clinical need. The real constraint in Montana is geography: long drives between homes eat into every margin, and a single complex case in a remote county may need a nurse who lives nearby. Agencies that do well tend to recruit locally around each case, pay mileage generously and avoid split shifts that double travel time.
Montana attaches prior authorization rules to every nursing code it bills:
- One rule each on S9123, S9124 and T1000.
- Six rules each on T1002 and T1003, the waiver nursing codes.
- 14 rules on T2025, a waiver services code.
No unit limits are listed on these codes. The heavier rule count on the waiver codes reflects that waiver services are tied to an individual service plan, so authorization is part of every new case. Agencies should confirm the authorized code, modifier and units before staffing and file renewals before an authorization ends.
Montana's programs are fee-for-service: Montana Medicaid and HMK Plus, the home and community-based waivers, and Community First Choice and Personal Care Services. Montana lists 17 plan and program arrangements, most of them primary care and care-management programs rather than risk-based plans that set their own nursing rates. For PDN agencies, that means the published fee schedule is the rate that applies.
Montana moved Passport to Health, CPC+ and PCMH into the new Primary Care Montana (PCMT) program on July 1, 2026. That change affects primary care, not nursing rates, but agencies may see new care coordinators involved in referrals. The Montana managed care page lists each arrangement.
Montana updates its fee schedules through Montana Administrative Register notices and state plan amendments. Recent items include:
- MAR Notice No. 2026-525.2, an adoption notice effective August 22, 2026, following the 2026-525.1 proposal.
- MAR Notice No. 2026-127.1, a proposal on updating provider rates and fee schedules, with a listed change of 3.39%.
- MAR Notice No. 2025-152.1, a proposal with a listed change of 3.0%.
- Multiple State Plan Amendments posted April 12, 2024, with a listed change of 7.01% effective July 1, 2024.
The current nursing rates all carry the July 1, 2025 effective date, and Montana published July 1, 2026 fee schedule updates, so agencies should check whether the 2026 update has reached the nursing lines.
Montana sits behind only a handful of states for RN private duty nursing: Utah at $254.03, Massachusetts at $130.64, Georgia at $95.36, Rhode Island at $94.40 and Hawaii at $94.04. At the bottom, Oklahoma pays $8.92 on T1000 and New Jersey $15.75 on S9123.
On the LPN side, Montana's $63.44 is the fifth-highest rate, against Mississippi's $14.95 and Oklahoma's $8.92 at the low end. A Montana LPN shift therefore pays more per hour than an RN shift in most of the bottom half of the country. For nearby comparisons, see South Dakota and Idaho private duty nursing rates.
Because every Montana line clears a median wage, the main intake question is reliability rather than price:
- Is the case state plan or waiver? The same nurse earns the agency more per hour on S9123 and S9124 than on T1002 and T1003.
- Which waiver authorized the hours? Big Sky, the DDP Comprehensive Waiver and the mental illness waiver each have their own case management.
- Where is the home, and who can reach it? Drive time is the main unpaid cost in a large rural state.
- Is authorization in place for each code? Waiver nursing codes carry six rules each.
Agencies that grow steadily in Montana tend to accept cases they can staff from nearby nurses, and to build referral relationships on the strength of filled shifts.
Rates on this page are compiled from official state Medicaid publications, and every rate links to its source document. For Montana, sources include the Montana Healthcare Programs fee schedules and Montana Administrative Register notices. The Montana rates page lists all 141,671 current Montana Medicaid rates across 8 programs.
Rankings compare each state's rate per hour for the same service and provider level. Our methodology explains how 15-minute rates are converted to hourly figures, and pricing covers full access to rate history and source links.