Medicaid Fee Calculator
Estimate your Medicaid reimbursement for home care services. Select your state, add service codes and units, and see what you can expect to be paid.
Encounter Details
Choose your state and add service codes to estimate reimbursement.
Select a state and service code, then click Add Charge to begin.
| Code | Description | Units | Rate | Total |
|---|
Estimated Medicaid Reimbursement
$0.00
Estimates Only
These rates are approximate and based on publicly available Medicaid fee schedules. Actual reimbursement may vary based on your specific payer contracts, provider type, service modifiers, and state program rules. Always verify rates with your state Medicaid agency or managed care organization.
How It Works
Estimate your reimbursement in 3 steps
Medicaid reimbursement rates vary significantly by state and service type. Our calculator uses publicly available fee schedule data to help you estimate what you can expect.
Select Your State
Medicaid is administered at the state level, so rates differ depending on where you provide services. Choose your state from the dropdown.
Add Service Codes
Select the HCPCS or CPT code for the home care service rendered and the number of units. Add as many charges as you need for the encounter.
View Your Estimate
The calculator shows the per-unit rate and total for each service, plus a combined estimated reimbursement for the entire encounter.
Understanding Home Care Medicaid Reimbursement
Medicaid reimbursement for home care services is managed at the state level, which means rates, covered services, and billing requirements can vary significantly from one state to another. Unlike Medicare, which follows a national fee schedule, each state's Medicaid program sets its own rates for personal care, home health aide, skilled nursing, and other in-home services.
Common Home Care Service Codes
Home care agencies typically bill Medicaid using HCPCS (Healthcare Common Procedure Coding System) codes. Some of the most frequently used codes include T1019 for personal care services, S5125 for attendant care, S5130 for homemaker services, and G0299 for direct skilled nursing. Each code represents a specific type and duration of service, usually billed in 15-minute increments or per visit.
Factors That Affect Reimbursement
Several factors influence what your agency will actually receive for a given service. Your state's fee schedule sets the baseline rate, but managed care contracts may pay differently. Provider type, geographic region within the state, and whether the service is delivered under a waiver program can all impact the final reimbursement amount. Some states also apply rate modifiers for services delivered during evenings, weekends, or holidays.
Why Accurate Billing Matters
Submitting clean claims with the correct service codes, modifiers, and documentation is critical to getting paid on time. Errors in billing—such as using the wrong code or mismatching service times with EVV records—can lead to denials, delayed payments, or even audit risk. This is why many agencies rely on integrated billing software like GeoH to automate claim scrubbing and reduce manual errors.
Want to maximize your Medicaid reimbursement?
GeoH's SMART Billing catches errors before submission and helps agencies achieve a 95% first-pass claim rate. Let us show you how.