Home health agency all-discipline encounter rate: Medicaid rates by state

A billing code alone doesn't make a fair comparison: states bill home health agency all-discipline encounter rate under different codes, units and provider types. This benchmark lines up one comparable rate per state.

• Provider level. States are compared at the same provider level wherever the schedule distinguishes one. Rates for other levels on file (any qualified provider) are kept separate, never mixed into this ranking.
• Unit. All 1 states publish their headline rate per encounter, so the amounts compare directly. The ranking uses the rate as published, so read the unit before comparing two states.
• Variants. 1 of the 1 states publish more than one rate for this service (by modifier, program, setting or provider type); the headline rate is the one that matches the comparison, and the workspace lists every variant.
• Depth. 57 rates for this service are on file across all states, versions and provider levels; this page shows one headline rate per state.

The highest-paying state, North Dakota, pays $233.95; the lowest, North Dakota, pays $233.95. 1 of the 1 states pay above the median of —. Common reasons rates for home health services spread this way:

• 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.

Billing notes

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.