The Florida Medicaid private duty nursing fee schedule 2026 has the biggest change in Private Duty Nursing (PDN) laws and funding in 10 years. With a $717 million in healthcare funding under the Live Healthy Legislative Package (SB 7016), reimbursement rates for nursing services have increased, helping HHAs attract top nursing staff.
At the same time, MCOs like Sunshine Health, Simply Healthcare, and Humana are using AI systems to detect billing errors, such as cloned documentation, EVV overlaps, and modifier mistakes. Consequently, this guide helps billing teams understand the new 2026 rates, codes, modifiers, and legal requirements while protecting agencies from financial loss and audits.
2026 Florida Medicaid Private Duty Nursing Fee Schedule 2026
For the first time in Florida history, nurses are being paid this much per hour. These updates (Florida Medicaid Private Duty Nursing rates ) apply to services provided 24 hours a day: the Registered Nurse (RN) under Code S9123 at $32.23 per hour, and the Licensed Practical Nurse (LPN) under Code S9124 at $28.14 per hour.
Furthermore, your billing team should remember that when submitting claims to the computer system, the codes S9123 for RN and S9124 for LPN must be used to ensure accurate payment under the current Florida Medicaid Private Duty Nursing fee schedule 2026.
Complete 2026 AHCA PDN Rate
| Code | Modifier 1 | Modifier 2 | Service Description | Maximum Fee |
| S9123 | — | — | RN private-duty nursing, up to 24 hours/day | $32.23/hr |
| S9123 | TT | — | RN PDN – multiple recipients, same location | $32.23 (1st); $16.12 (2nd); $8.06 (3rd+) |
| S9123 | UF | — | RN PDN – coordinated with another provider, same setting | $32.23/hr |
| S9123 | TT | UF | RN PDN – multiple recipients + multiple nurses | $32.23 (1st); $16.12 (2nd); $8.06 (3rd+) |
| S9124 | — | — | LPN private-duty nursing, up to 24 hours/day | $28.14/hr |
| S9124 | TT | — | LPN PDN – multiple recipients, same location | $28.14 (1st); $14.07 (2nd); $7.03 (3rd+) |
| S9124 | UF | — | LPN PDN – coordinated with another provider, same setting | $28.14/hr |
| S9124 | TT | LPN PDN – multiple recipients + multiple nurses | $28.14 (1st); $14.07 (2nd); $7.03 (3rd+) |
Key Billing Notes That Affect Reimbursement
If your nurse works more than 30 minutes in the last hour of a shift, the incomplete hour can be rounded up to 1 full hour in billing. However, the condition is that the total hours do not exceed the Authorized Hours for the patient.
Multiple Nurses and Case Sharing Rules (Modifier TT)
If more than one nurse or provider is giving services to the same patient on the same day, then the TT Modifier must be applied at the time of billing. In addition to this rule:
- The names of all patients/recipients who were provided services must be written on the billing form.
- It is strictly prohibited to submit separate claims for the same case from different providers.
Coordination with Another Agency (Modifier UF)
If you are giving services in the same location as another home health agency, you must use the UF Modifier. Importantly, all rates provided by Florida Medicaid are for each provider/agency; these rates are not shared between agencies.
Understanding the Core Procedure Codes
S9123, Registered Nurse (RN) Private Duty Nursing
What S9123 Covers and When to Use It?
S9123 is a specific healthcare code (HCPCS Level II Code), with a base rate of $32.23 per hour in 2026. This code is used only for patients who are medically fragile and require nursing care that can only be provided by a registered nurse (RN). The main medical services covered by this code are:
- Designing, cleaning, and evaluating complex lines in the body.
- Performing a detailed examination of the lungs and breathing, and managing ventilator machines.
- Making quick and accurate medical decisions in critical situations when a patient’s condition suddenly worsens to save the patient’s life.
The RN vs. LPN Cost Analysis for Florida Agencies
The difference in rates between code S9123 (RN) and code S9124 (LPN) is only $4.09 per hour. As a result, many Florida home health agencies (HHAs) are now finding that hiring a registered nurse (RN) for complex cases can actually be more cost-effective and beneficial. The main reasons for this are:
- According to Florida state law, if you hire an LPN nurse on a case, a supervisory visit is required by a senior nurse to oversee the case, which is a separate cost to the agency.
- Alternatively, if an RN is on the case from the beginning, the additional cost and hassle of this mandatory supervisory visit are eliminated.
- Therefore, instead of blindly sending an LPN nurse to any case, agencies should first conduct a Cost-Benefit Analysis of each case to determine whether it is more beneficial to have an RN or an LPN there.
S9124, Licensed Practical Nurse (LPN) Private Duty Nursing
What S9124 Covers and When to Use It
S9124 is also a specific healthcare code (HCPCS Level II Code), with a base rate of $28.14 per hour in 2026. This code is considered the backbone of Florida’s PDN program, as it is used for most 24-hour nursing shifts across the state. These services are typically provided by a Licensed Practical Nurse (LPN). Common medical services covered under this code are:
- Daily cleaning and care of a tracheal tube (trachea) when the patient is stable.
- Providing food and nutrition to a patient through a gastrostomy tube.
- Administering daily medications to a patient on time as directed by a physician.
- Catheter management and examination, and dressing of common wounds.
LPN Supervision Requirements Under Florida Law
If you assign an LPN to a case, a registered nurse (RN) is required to visit the case and maintain a regular record of the supervisory visit, as per the patient’s Plan of Care. Failure to conduct or maintain a supervisory visit is one of the biggest mistakes caught in audits of Florida Medicaid MCOs.
Therefore, whenever your billing team or agency calculates profit and chooses the S9124 (LPN) model over the S9123 (RN), it must factor in the additional cost and time of this supervisory visit from the total profit, or you could face a hefty audit penalty.
Florida Medicaid PDN Modifier Codes
In 2026, modifiers must be absolutely accurate; there is no compromise. If even one modifier is missing or incorrect, the system will automatically reject your claim as duplicate service. This is because the government’s (AHCA) computer system will think you are claiming the same hour twice.
TT Modifier (Multiple Patients at the Same Location)
The TT Modifier is used when the same nurse is providing care to multiple patients at the same time, in the same home or location. This is typically the case in homes with two or more siblings who need specialized medical care.
TT Modifier Payment Method in 2026
When a nurse sees more than one child, Florida Medicaid does not pay full rates for each additional child, but rather halves or quarters the rates:
Registered Nurse Rates (RN – S9123 TT)
- 1st Recipient: $32.23 per hour (full 100% rate)
- 2nd Recipient: $16.12 per hour (50% rate)
- 3rd or more patients (3rd+ Recipient): $8.06 per hour (25% rate)
Licensed Practical Nurse Rates (LPN – S9124 TT)
- 1st Recipient: $28.14 per hour (full 100% rate)
- 2nd Recipient: $14.07 per hour (50% Rate)
- 3rd or more patients (3rd+ Recipient): $7.03 per hour (25% rate)
Financial Warning for Companies
If there are three children in a household and a registered nurse (RN) is on duty, the blended rate for all three children would be approximately $18.80 per hour. Before billing agencies, it is essential to calculate whether such a low average rate will cover the nurse’s salary and the company’s expenses. Nurse shifts should be designed accordingly.
The UF Modifier
When more than one home health provider or nurse is present in the same patient’s home at the same time, the UF Modifier must be applied to the billing. This situation typically occurs during a shift change, and the departing nurse is providing a clinical handoff to the incoming nurse, which takes 30 minutes.
An example of a shift change
Assume that a nurse from Agency A is on duty from 7:00 AM to 7:00 PM, and a nurse from Agency B comes in from 7:00 PM to 7:00 AM. At 7:00 PM, when both nurses are present together to share a report, both agencies must apply the UF modifier to their claims to bill for this overlap.
If the billing team does not apply the UF modifier to this shared time, the government (AHCA) system will block the claims from both agencies as duplicate services. This error could cause your payment to be held for 60 to 90 days (2 to 3 months), severely impacting the company’s cash flow.
The TT + UF Combination
When to Use Them Together?
When two major events are occurring simultaneously in the same home during the same shift, the billing team must use both the TT and UF modifiers together, i.e., S9123 TT UF (for RNs) or S9124 TT UF (for LPNs).
Specifically, this particular combination is only used when a home has multiple siblings and nursing teams from two different agencies are in the home at the same time during the shift change.
Why is this Important?
When these two codes are entered into the system together, the insurance company’s computer recognizes that more than one child is being cared for and that the nurses are legally transferring charges to each other (clinical handoff). Otherwise, if these two modifiers are not entered together, the system will immediately reject the claim, and the money from both agencies will be blocked.
How the 30-Minute Rounding Rule Impacts Revenue?
How does the Rounding Law Work?
The official Florida Medicaid rate card states a very important rule: If a nurse works more than 30 minutes (i.e., 31 minutes or more) in the last half hour of a shift, she can be billed for the next full hour. But the condition is that the total hours do not exceed the patient’s daily authorized hours.
Real-World Revenue Impact
Assume a nurse works an 8-hour, 35-minute shift:
- This method will only bill for 8.5 hours.
- Since half an hour is more than 30 minutes (i.e., 35 minutes), you can bill for the full 9 hours.
- If your patient is on 24/7 care and your billing team does not apply this rule to every shift, you could be losing about $11,700 per patient, annually, based on registered nurse (RN) rates, which is what you are entitled to.
How to Improve Billing in 2026
Set your EVV (Electronic Visit Verification) software to automatically highlight any shifts where more than 30 minutes of work was done in the last hour. The billing team must review these highlighted shifts before finalizing claims to ensure that a full hour is claimed.
This small change could save your agency thousands of dollars in legitimate revenue annually at no additional cost.
Florida Medicaid Private Duty Nursing coverage 2026
Pediatric PDN
House Bill 1261
House Bill 1261, enacted in 2026, now mandates that children under 21 living in group homes be paid the same hourly rate as children living at home. Essentially, this law eliminates the old distinction that previously made agencies reluctant to send nurses to group homes.
PPEC Interaction
If a child attends a PPEC (specialized pediatric day care center), billing for home nursing services (S9123 or S9124) is considered a major billing violation of 2026 and is subject to immediate audit.
If the child was in the PPEC center for 8 hours, the full 8 hours will be deducted from your home’s approved nursing hours. Meanwhile, insurance companies’ (MCOs) computer systems now match PPEC center attendance times and your nurse’s EVV time, so there is no room for error.
Adult PDN
The Stability Trap and Nursing Hour Reductions
For adult patients covered by long-term care (LTC), insurance companies (MCOs) often change the patient’s status from Nursing (S9124) to Home Health Aide (HHA – Unskilled) as soon as the patient’s condition is stable. This change results in the cessation of nursing payments. If nursing reports do not demonstrate that the patient needs a nurse, the hours are reduced.
Documenting to Prevent LTC Skill-Level Downgrades
To prevent a patient from being downgraded, nursing reports should clearly document tasks that only a licensed nurse can perform under Florida law, such as:
- Insertion and care of a urinary tract infection.
- Examination and dressing of deep and complex wounds.
- Methods of bowel and bladder cleansing that require the nurse’s clinical judgment.
- Assessing the patient’s condition and adjusting the medication as directed by the physician.
How to Document Nighttime Nursing Hours to Avoid Claim Denials
Why are Insurance Companies Denying Nighttime Hours in 2026?
Today, insurance companies (MCOs) are denying approval for nighttime nursing hours by saying that the patient is sleeping at night, so they don’t need a registered nurse (RN) or medical assistance. If your agency’s case is cut to nighttime hours, the revenue from that case can drop by as much as 50%.
D-I-E Framework for Nursing Reports
To prove that night nursing services are legitimate and necessary, all nursing reports must be written according to the D-I-E method (Data, Intervention, Evaluation) to prove that the nurse was actively caring for the patient at night.
Data (data on the patient’s current condition)
Record the patient’s ventilator settings, lung sounds, oxygen saturation (SpO2), and other vital signs at regular intervals to track the patient’s changing condition.
For example, at 2:15 AM, the oxygen saturation (SpO2) dropped to 83% and the pulse oximeter alarm started sounding.
Intervention (immediate medical action by the nurse)
Write down in detail the skilled action the nurse took based on the data or symptoms.
For example, tracheal suctioning was performed, and approximately 5 ml of clear material was removed. The inner cannula was replaced. Patient’s sitting/lying position was changed at 2:30 and 4:30 am to protect the skin from injury.
Evaluation (Result of medical intervention)
Write down how the patient’s condition improved after the nurse’s intervention and what his current condition is.
For example, within 4 minutes of suctioning, oxygen returned to 97%. The patient tolerated the procedure without any discomfort. Respiratory status is now stable.
If the nursing report only states the patient slept well, no issues noted, insurance company auditors will consider this to be a normal employee’s duty rather than a nurse’s medical service. Undoubtedly, this one line will result in your entire shift being deducted.
2026 Smart Audit Era
Here’s how the Florida Health Care Administration’s (AHCA) Artificial Intelligence (AI) systems catch billing errors and what major benefits APRN nurses are bringing to agencies in 2026:
How AHCA’s AI Audit Systems Detect Documentation Issues
Florida Medicaid and all major insurance carriers (MCOs) are now using advanced AI software that catches these three major nursing report (documentation) errors in seconds:
Cloned Notes
If a nurse has copied and pasted the same report for 3 or more consecutive shifts, the AI catches it immediately.
EVV Timestamp Conflicts
If two different providers or nurses at the same home address have clock-in / clock-out conflicts.
Modifier Errors
When computer data shows that there was more than one patient or nurse in the home, but the billing team did not apply the TT or UF modifier to the claim.
Severe Penalty
If a patient’s nursing report is found to be identical for 3 consecutive days, the AI system will automatically flag the case for audit. As a result, the insurance company will reduce the payment for all those days from the nursing rate to the unskilled rate, which will cause a huge loss to the company.
The APRN Advantage: A Key 2026 Policy Change
Under new Florida laws, Autonomous Advanced Practice Registered Nurses (APRNs), i.e., highly qualified nurses, have now been given the legal right to sign the patient’s treatment plan (Plan of Care – POC) and PDN orders themselves.
Previously, agencies had to wait for a doctor’s signature to start treatment or renew it under the House Bill, which often caused billing to be stuck for weeks. In 2026, agencies that have relationships with APRN nurses can get POCs signed much faster than doctors. Consequently, this eliminates the authorization gap and keeps the company’s revenue flowing without interruption.
Frequently Asked Questions (FAQs)
Q1: Will Medicaid pay for nursing homes in Florida?
Ans. Yes, Florida Medicaid covers nursing home care for eligible low-income individuals who meet medical and financial criteria.
Q2: Does the state of Florida pay you to be a caregiver?
Ans. Yes, through programs like the Medicaid Statewide Medicaid Managed Care Long-Term Care (SMMC-LTC) waiver, Florida can pay family members to serve as caregivers.
Q3: What are the requirements to get into a nursing home in Florida?
Ans. You must be 65+ or disabled, require a nursing-facility level of care, and meet Florida Medicaid’s income and asset limits (generally income under $2,829/month and assets under $2,000).
Conclusion
The Florida Medicaid private duty nursing fee schedule 2026 is offering the highest rates in history, $32.23 per hour for RNs and $28.14 per hour for LPNs. But to get that full amount and avoid an audit, your billing, nursing reporting, and software management must be absolutely perfect.