Private duty nursing Medicaid rates in Pennsylvania rest on one number that has stood for a long time. Pennsylvania Medical Assistance lists $50.00 an hour on code S9123 for RN private duty nursing, effective since 2008-08-01, which ranks 25th of 43 states and sits 8.8% below the $54.84 national median. The same $50.00 applies to LPN care on S9124, where it ranks 16th of 39 states, 13.4% above the LPN median.
A flat rate for both nurse levels, in place since 2008, sits alongside separate fee increases for shift nursing for children under 21 and a HealthChoices add-on paid through managed care. Every rate here is compiled from official state Medicaid publications and links to its source document on the Pennsylvania Medicaid rates page.
| Service | Code | Rate | Rank | vs national median |
|---|---|---|---|---|
| PDN, RN | S9123 | $50.00 an hour | 25 of 43 | -8.8% |
| PDN, LPN | S9124 | $50.00 an hour | 16 of 39 | +13.4% |
| Waiver nursing, LPN | T1003 | $12.50 per 15 min ($50.00 an hour) | 19 of 34 | -11.4% |
The same $50.00 hourly figure appears on all three lines. For the state plan, it means the payer does not distinguish RN from LPN time. For LPN care, that makes Pennsylvania an above-median state; for RN care, a below-median one.
Waiver nursing on T1002 and T1003 has been in effect since 2022-10-01. The LPN rate is $12.50 per 15 minutes. The RN waiver listing on T1002 is not ranked in our hourly comparison.
A base rate that has stood since 2008-08-01 is one of the oldest in our national nursing data. It does not mean every Pennsylvania PDN shift is paid at exactly $50.00 today, because later notices and managed-care payments sit on top of the base listing. But it does mean the base listing itself has not been reset for general wage growth in nearly two decades.
For an agency, the practical reading is that the base fee schedule is a reference, not the full payment picture. The amount a shift actually earns depends on the patient's age, the program, and, for plan members, the agency's contract plus any directed payment. Billing teams should map each case to the notice or contract that governs it, rather than relying on the base figure.
Pennsylvania's rate history for private duty nursing centers on children. The Medical Assistance Program published fee increases for private duty/shift nursing services to MA beneficiaries under 21 twice:
- Effective 2016-07-01, with a listed change of 12.5%.
- Effective 2022-01-01, with a listed change of 11.11%.
A further notice, Medical Assistance Program Fee Schedule Addition; Private Duty Nursing, took effect 2023-01-01.
For a pediatric PDN agency, these notices matter as much as the base listing. The rate a child's shift is paid at may differ from the base S9123 and S9124 figures, so billing teams should check each notice against the patient's age and program. When a patient turns 21, the rate basis can change, and the transition should be planned with the family and the payer well in advance.
Pennsylvania's program list includes the HealthChoices private duty nursing $5/hour uniform increase, a state directed payment. CMS approved Pennsylvania state directed payment preprint renewals for 2024 (approved 2023-12-26) and for 2026 (approved 2025-12-04).
A uniform hourly increase directed through HealthChoices means that, for members enrolled in managed care, plans pay the add-on on PDN hours under the terms the state sets. For agencies with a large HealthChoices caseload, this is a meaningful part of revenue per hour and should be tracked as its own line in remittance reviews. Confirm with each plan how the increase appears on remittances, and check that it is applied to every eligible hour.
Pennsylvania nurse wages sit almost exactly at the national median. Federal wage data for May 2025 put the state median at $46.36 an hour for registered nurses (US: $46.90) and $30.74 for licensed practical nurses (US: $30.96).
At the flat $50.00 rate:
- RN private duty nursing: the loaded median RN wage is 131.8% of the rate. The line runs at a loss once payroll taxes and benefits are added.
- LPN private duty nursing: loaded wage share 87.4%, leaving a margin of $6.31 an hour after loaded wages.
- LPN waiver nursing: the same $50.00 rate and the same $6.31 hourly margin.
The flat rate pushes Pennsylvania agencies toward LPN staffing wherever a patient's plan of care allows it. An RN shift at the base rate does not cover a median RN's loaded cost. Agencies with high-acuity patients who require RN-level care, such as children on ventilators, depend on the under-21 increases, the HealthChoices add-on and plan contracts to make those cases work.
Pennsylvania's coverage data list prior authorization rules on every nursing code we track:
- 3 rules on S9123.
- 2 rules each on S9124, T1002 and T1003.
- One rule on T2025, a waiver services code.
No unit limits are listed. Authorization ties the hours on each case to a plan of care, so the approved hours, not just the hourly rate, drive what a case is worth. With several rules per code and separate processes for fee-for-service and each plan, intake teams should keep a per-payer checklist and confirm that each authorization covers the credential, hours and dates before staffing.
Pennsylvania runs Medical Assistance fee-for-service alongside managed care, including HealthChoices and Community HealthChoices for long-term services and supports. Our records list 18 plan arrangements, among them AmeriHealth Caritas Pennsylvania, Keystone First, Geisinger Health Plan, PA Health & Wellness, UPMC for You and Jefferson Health Plans EverWell.
For private duty nursing, the rule on file is that plans negotiate; the published rate applies out of network. Home and community-based services and home health follow the same rule. Personal care is different: plans must pay at least the published rate.
In practice, the fee schedule is the reference point, and each plan's contract sets what an in-network agency is paid, with the directed $5/hour increase on top for eligible hours. Agencies should negotiate from their loaded cost per RN and LPN hour, since the base rate does not cover a median RN. The Pennsylvania managed care page lists the rules by service line.
Pennsylvania's waiver programs include the ODP intellectual disability and autism waivers (Consolidated, Community Living and Person/Family Directed Support), the OBRA Waiver for adults with developmental physical disabilities and the ODP Adult Autism Waiver. Several older waivers, including the Aging, Independence and Attendant Care waivers, were replaced by Community HealthChoices. The Office of Long-Term Living renewed the OBRA Waiver and amended Community HealthChoices with 2026-07-01 effective dates.
For a nursing agency, the program determines the payer: ODP waivers are paid by the state, while Community HealthChoices services are paid through the plans.
Pennsylvania announces Medical Assistance fee changes through notices in the Pennsylvania Bulletin, and 2026 has been an active year. The 2026 Healthcare Common Procedure Coding System Updates; Fee Adjustments and Other Procedure Code Changes took effect 2026-08-01, and the Office of Long-Term Living published waiver amendments and renewals effective 2026-07-01. None of the notices on file changes the base S9123 or S9124 figure.
That does not make them irrelevant to a nursing agency. HCPCS update notices can add, end-date or reprice codes that sit next to private duty nursing on the same claims, and waiver amendments can change who qualifies for which services. A short monthly review of new Bulletin notices, with a check for any reference to private duty or shift nursing, is the simplest way to catch a change before it reaches remittances.
For RN private duty nursing, Utah pays $254.03 an hour, Massachusetts $130.64, Georgia $95.36, Rhode Island $94.40 and Hawaii $94.04. At the bottom are Virginia ($25.86), New Jersey ($15.75) and Oklahoma ($8.92). Pennsylvania's $50.00 sits near the middle, and neighboring New York and Ohio offer useful cross-border comparisons.
For LPN care, Massachusetts leads at $90.96 and Mississippi, New Jersey and Oklahoma are lowest.
- Map each case to its payment basis: base schedule, under-21 notice, HealthChoices contract plus directed payment, or ODP waiver.
- Staff to the margin. LPN hours cover their cost at the base rate; RN hours need the add-ons.
- Audit the $5/hour increase on HealthChoices remittances.
- Plan age transitions for pediatric patients approaching 21.
- Compare related lines, such as home health in Pennsylvania, and the national private duty nursing hub.
All Pennsylvania rates on this page are compiled from official Pennsylvania Medical Assistance publications, including notices published in the Pennsylvania Bulletin and the state directed payment preprints approved by CMS. Each rate on the Pennsylvania Medicaid rates page links to its source document and effective date. National ranks compare published hourly rates for the same service and provider level, and wages are federal May 2025 state medians. Our methodology explains how hourly figures are compared, and all 49,804 current Pennsylvania Medicaid rates are available on our plans.