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    v1.0.30
    OpenPayerBilling CodesTemporary National Codes (Non-Medicare)HCPCS hcpcs-s9124-licensed-practical-nurse-home-care-hourly
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    HCPCS S9124: Nursing Care in Home by Licensed Practical Nurse, Per Hour

    Commercial payers pay $33 on average nationally for this procedure.

    HCPCS Level II code S9124 describes nursing care provided in the home by a licensed practical nurse, billed per hour; the service type is home nursing (LPN) hourly care and the typical site of service is the patient's residence/home.

    For related coverage guidance, see recent payer policy updates: Medical Necessity Guidelines Non-Emergency Transportation, Non-Emergent Transportation Medical Policy, Non-Emergency Facility to Facility Transfers.

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    National Reimbursement Benchmarks

    Commercial reimbursement for HCPCS S9124 centers around an average commercial benchmark (BUCA) of $33.30, with individual payers showing meaningful variation. Blue Cross Blue Shield (BCBS) and Aetna book higher central tendencies — BCBS median $37.20 and Aetna a uniform $30.00 — while Cigna and UnitedHealth Group present lower medians at $11.10 and $9.80, respectively. BUCA’s mean of $33.30 sits between the higher BCBS values and the lower Cigna/UnitedHealth Group medians, indicating the commercial-market midpoint for this code.

    Rate dispersion (P75 minus P25) highlights concentration differences: UnitedHealth Group shows the widest interquartile spread at $40.00 (P75 $40.00 minus P25 $0.00), followed by BCBS at $17.80 and BUCA at $18.90. Aetna is the tightest with no dispersion (P75 $30.00 minus P25 $30.00 = $0.00), and Cigna’s spread is $13.90. These spreads illustrate which payers concentrate around a narrow band versus those with broader commercial variability.

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    National Payer Mean Reimbursement Rates

    State Reimbursement Rates

    State: Alaska1 / 51

    Rate by payer

    Clinical & Coding Specifications

    Clinical Context

    A 78-year-old patient lives at home with long-term dependence on a wheelchair (Z99.3) and recent bed confinement (Z74.01) following a hip fracture and surgical repair. The patient is on long-term anticoagulation (Z79.01) and requires routine therapeutic drug level monitoring (Z51.81) and wound/aftercare follow-up (Z48.89). A home health agency dispatches a licensed practical nurse to provide episodic skilled nursing care, assisting with medication administration, subcutaneous injections, wound dressing changes, basic assessments of vital signs and mobility, and reporting changes to the supervising clinician.

    The clinical workflow begins with a physician or nurse practitioner order for home nursing visits. The home health agency schedules visits and assigns a licensed practical nurse (163W00000X) or community health LPN (163WC1500X) to perform one-hour skilled nursing episodes billed with S9124. The LPN documents time on task, clinical findings, care provided (medication administration, wound care, education), and communicates any abnormal findings to the supervising registered nurse or ordering provider. Billing includes the appropriate payer and may append modifiers for circumstances such as bilateral services, reduced or discontinued services, or professional component adjustments when applicable. Typical payors include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, BUCA, and Medicare.

    Related CPT Codes

    Related Modifiers

    8 rows

    ModifierDescriptionWhen to Use
    59Modifier 59 indicates a distinct procedural service when two procedures that are not normally billed together are clinically and procedurally separate. The CPT definition (as reiterated by CMS)…- Use modifier -59 to report a distinct procedural service when documentation supports that the procedure reported is not normally billed together with another service on the same day because of a…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    76Modifier -76, Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional, is appended when the same provider performs an identical, medically necessary procedure or…- Use modifier -76 when the same physician or other qualified health care professional performs an identical procedure or service a second (or subsequent) time on the same date of service and the…
    78CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…
    22Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
    26Modifier 26 (Professional Component) identifies and bills only the professional portion of a split service — the physician’s interpretation, report, and medical judgment — when the technical…- Use CPT Modifier -26 when you are billing only the professional component (PC) of a split‑bill eligible service—i.e., you performed the physician interpretation, medical judgment and prepared a…
    51Modifier –51 (Multiple Procedures) is used when the same provider performs multiple procedures in the same session to identify secondary, non‑exempt procedures and indicate payment reduction logic…- Use modifier -51 when the same provider performs multiple distinct procedures during the same patient encounter: report the highest‑valued procedure first (no modifier) and append -51 to…

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    163W00000X
    163WC1500X
    251J00000X
    261QP1100X
    320800000X
    261QA3000X
    207RC0001X
    1835G0000X

    Related Payer Policy Updates

    Specialty: Emergency & Medical Transportation1 / 3

    10 rows

    PolicyPayerEffective Date
    Medical Necessity Guidelines Non-Emergency TransportationMass General Brigham Health Plan2026-11-01
    Non-Emergent Transportation Medical PolicyHealth-New-England2026-11-01
    Non-Emergency Facility to Facility Transfershap_caresource_mi_coordinated_health2026-11-01
    Ambulance and Medical Transport Services (Ground, Air and Water) Corporate Medical Policybcbsvermont2026-10-01
    Emergency Air/Water Ambulance Services Medical GuidelineWPS Health Insurance2026-10-01
    Non-Emergent Ambulance ServicesConnectiCare2026-09-11
    Fixed Wing Air Ambulance TransportCigna2026-08-15
    Air AmbulanceAmbetter Georgia2026-08-01
    Ambulance Services (for Tennessee Only)UnitedHealthcare2026-08-01
    Ambulance Services (for New Mexico Only)UnitedHealthcare2026-08-01

    Related Codes

    HCPCS-LEVEL-II-S2152-SOLID-ORGAN-TRANSPLANTATION-GLOBAL-CARE

    HCPCS Level II S2152: Solid Organ Procurement and Transplantation

    HCPCS-LEVEL-II-S2266-INDUCED-ABORTION-29-TO-31-WEEKS

    HCPCS Level II S2266: Induced Abortion, 29 to 31 Weeks

    HCPCS-LEVEL-II-S3630-EOSINOPHIL-COUNT-BLOOD-DIRECT

    HCPCS Level II S3630: Eosinophil Count, Blood, Direct

    HCPCS-LEVEL-II-S4017-INCOMPLETE-ART-CYCLE-CANCELLED-PRIOR-TO-STIMULATION

    HCPCS Level II S4017: Incomplete Cycle — Cancelled Prior to Stimulation

    HCPCS-LEVEL-II-S8055-ULTRASOUND-GUIDANCE-MULTIFETAL-REDUCTION-TC

    HCPCS Level II S8055: Ultrasound Guidance for Multifetal Pregnancy Reduction

    HCPCS-LEVEL-II-S8940-EQUESTRIAN-HIPPOTHERAPY-PER-SESSION

    HCPCS Level II S8940: Equestrian/Hippotherapy, Per Session

    HCPCS-LEVEL-II-S9024-PARANASAL-SINUS-ULTRASOUND

    HCPCS Level II S9024: Paranasal Sinus Ultrasound

    HCPCS-LEVEL-II-S9366-HOME-TPN-1-2L-PER-DAY-HOME-INFUSION

    HCPCS Level II S9366: Home Infusion TPN, 1–2 L/day

    HCPCS-LEVEL-II-S9446-GROUP-PATIENT-EDUCATION-NON-PHYSICIAN

    HCPCS S9446: Patient Education, Non-Physician Provider, Group, Per Session

    HCPCS-LEVEL-II-S9451-EXERCISE-CLASS-NON-PHYSICIAN-SESSION

    HCPCS S9451: Exercise Classes, Non-Physician Provider, Per Session

    Showing 1–10 of 532

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    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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    Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

    CPT CodeDescriptionRelationship to This Procedure
    S9123Nursing care, in the home; by registered nurse, per hourRN-level counterpart to S9124; used when a registered nurse provides the hourly skilled visit instead of an LPN
    99503Home visit for respiratory therapy careMay be performed alongside S9124 when the patient requires respiratory therapy support during the home nursing episode
    99504Home visit for mechanical ventilation careRelated when patients have complex ventilatory needs and coordinated nursing and respiratory services occur in the home
    99509Home visit for assistance with activities of daily living and personal careNon-skilled or personal care services that may be coordinated with skilled nursing visits billed with S9124