How are home health nurses and therapists paid, and how do productivity points work?
The short answer
Medicare pays the agency, and the agency decides how to pay you: by the visit, by the point, by the hour, or on a salary with a weekly target. A points system gives each kind of visit a weight and sets a weekly total. There's no published normal weekly total that we found, so treat any number you hear as one agency's rule. Before you sign, find out what each visit is worth and how travel, notes, meetings and missed visits are paid.
Medicare pays the agency, not you, and your employer decides how your paycheck is built, inside federal and state wage law.
Fine print
Medicare pays a home health agency a standard amount, adjusted for each patient's case, for each 30-day period of a patient's care. It pays the clinician nothing directly.
Four ways agencies pay you
- Per visit. You get a set amount for each visit, often different for different kinds of visit.
- Points. Each kind of visit is worth a number of points. You're paid per point, or you're salaried against a weekly points target.
- Hourly. You get a wage for the hours you work.
- Salary. You get a fixed amount per pay period, with or without a visit target.
Fine print
Two published counts exist, and they measure different things. In a 2019 industry salary survey of 1,028 agencies, 69.86% reported using an hourly pay mode, up from 63.61% the year before. The summary does not say which staff that covers. In the speech-language pathologists' 2025 survey, 47% of those working in home health agencies or clients' homes were paid per visit.
How a points system works
A points system gives each kind of visit a weight, and gives you a total to reach each week. Each agency sets its own, so treat any number you hear as that agency's rule. Some clinicians have no target at all.
Fine print
No association statement or study that we could find publishes typical weights. The only public examples are clinicians describing jobs they hold or were offered, in three forum threads from 2025. A therapist was offered a job with a target of 27 points a week and a start of care worth 2 points; a commenter in the same thread gave an example of 1 point for a follow-up visit, 1.5 for an evaluation and 2.5 for a start of care. Another clinician reported 30 points a week, with a routine visit at 1 point, a start of care at 2.4, evaluations and recertifications at 1.5 and a discharge with an assessment at 1.25. A job applicant posting in a nursing forum was told 25 points a week, with a routine visit at 1.5 points. These are a handful of individual reports. Per-visit rates also differ by kind of visit: in the 2019 salary survey, registered nurses averaged $91.70 for an admission visit and $69.62 for a recertification visit. In the 2025 speech-language pathology survey, about two-thirds of those in home health reported no productivity requirement. The physical therapy association (APTA) position on productivity standards is that it "supports productivity standards that balance the patient experience and outcome, respect clinical judgment, adhere to the APTA Code of Ethics, consider the economics of care delivery models, and improve the work experience of the providers."
Is there a normal weekly total?
We found no standard weekly number, so ask what yours is. The same total can mean two very different weeks, depending on how many points each visit is worth. A weekly total also leaves out how far you drive.
Fine print
We found no published figure for a typical weekly target, from the nursing and therapy associations or in the public summaries of the main industry salary survey. Twenty-seven points over five days is 5.4 points a day. At 1 point a visit, that is five or six visits a day. At 1.5 points a visit, it is three or four. Chapter 2 gave the two published measurements of visits per day that we could find, 4.2 and 6.7.
Travel, notes and waiting
Pay plans differ on driving, notes, meetings and waiting. If you're paid by the hour, federal rules cover part of it. When overtime rules cover you, travel from one patient to the next during the workday counts as hours worked, and normal travel from home to work doesn't. On-call time counts as work when you're tied to the employer's premises, and not when you only have to leave word where you can be reached.
Fine print
This covers employees covered by overtime rules. On-call time counts when you must stay on the employer's premises, or so close to it that you cannot use the time effectively for your own purposes. It does not count when you only have to leave word where you can be reached. The rule's example of travel that counts is "travel from job site to job site during the workday." The rules are 29 CFR 785.38 (travel that is all in the day's work), 785.35 (home to work) and 785.17 (on-call time).
Overtime for nurses
Labor Department guidance for nurses says that if you're a registered nurse paid by the hour, you should get overtime pay. It also says a registered nurse who meets the duties tests and is paid a salary of at least $684 a week may be classified as exempt from overtime. If you're a licensed practical nurse, it says you generally don't qualify as exempt and are entitled to overtime.
Fine print
The guidance says registered nurses paid by the hour "should receive overtime pay." It says licensed practical nurses "generally do not qualify as exempt learned professionals." Registered nurses who meet the duties tests and are paid a salary of at least $684 a week "may be classified as exempt." We found no federal page that addresses physical therapists, occupational therapists or speech-language pathologists in the same way. Source: Fact Sheet 17N, revised September 2019.
Per-visit pay
Per-visit pay is less clear. Whether per-visit pay counts as a "fee" under the federal rules is a legal question. Your employer can tell you whether your position is classified as exempt from overtime.
Fine print
Federal rules treat pay as a fee when it is "an agreed sum for a single job regardless of the time required for its completion." The same rule says such payments "resemble piecework payments with the important distinction that generally a 'fee' is paid for the kind of job that is unique rather than for a series of jobs repeated an indefinite number of times and for which payment on an identical basis is made over and over again." (29 CFR 541.605.)
When a patient cancels
Your agency's pay plan sets what you're paid when a patient cancels or isn't home, so ask what it says. State rules can be stricter than federal ones, so ask about your state too.
Fine print
We found no federal rule that says what you are paid when a patient cancels or is not home. Oregon passed a bill in 2025 saying a home health agency "may not compensate home health care staff providing home health services for the agency on a per-visit basis." One survey has a number on unpaid time: in 2025, 33% of home health speech-language pathologists paid by the hour, the visit or per diem reported working "off the clock" typically daily.
Mileage
Ask what your agency pays per mile. Some states have their own mileage rules.
Fine print
We found no federal rule that sets a mileage rate for employers. California's labor code says an employer must cover "all necessary expenditures or losses incurred by the employee in direct consequence of the discharge of his or her duties". For comparison, the IRS business rate was 72.5 cents a mile from January through June 2026 and is 76 cents a mile from July 1, 2026.
Employee or contractor
Some therapists work as independent contractors. A contractor isn't an employee, and the wage figures below leave contractors out.
Fine print
The IRS sorts the evidence for telling the two apart into three categories: behavioral control, financial control and the type of relationship.
Questions to ask before you sign
Before you take a job, find out how you're paid (per visit, per point, hourly or salary) and whether the position is classified as exempt from overtime. Find out what each kind of visit is worth and what the weekly target is. And find out what you're paid when a patient cancels or isn't home, and whether travel between patients is paid.
Fine print
The kinds of visit to ask about are routine, start of care, resumption of care, recertification, discharge and evaluation. Other questions to settle: what happens when you are over or under the target, how long the ramp-up is before the full target applies to you, what the mileage rate is, how meetings, training, case conferences and on-call time are paid, whether charting time is built into the visit rate, whether you are an employee or a contractor, and what benefits come with the job. The one association list of questions that we could find sits behind a login, so this list is ours. A 2014 guide from the physical therapy association's home health section lists, among orientation topics, a job description that may include productivity expectations, in-home visit time expectations, documentation expectations and on-call expectations.
What the pay data shows
Federal wage data for May 2025 puts the median home health registered nurse at $84,930 a year and the median home health physical therapist at $114,740. The table has the rest, as annual medians.
| Occupation | Home health care services | All industries |
|---|---|---|
| Registered nurse | $84,930 | $97,550 |
| Licensed practical nurse | $63,580 | $64,400 |
| Physical therapist | $114,740 | $102,760 |
| Occupational therapist | $106,300 | $100,330 |
| Speech-language pathologist | $117,370 | $97,870 |
| Physical therapist assistant | $80,050 | $68,380 |
The table leaves out contractors and mixes hourly, salaried and per-visit jobs.
Fine print
The Bureau of Labor Statistics publishes pay by occupation and industry. The table counts wage and salary jobs and leaves out contractors. It combines hourly, salaried and per-visit jobs. It cannot show what a clinician paid per visit earns for each hour worked. For per-visit pay, the only recent published figure that we could find is for speech-language pathologists: in the 2025 survey their median was $75.00 a visit in home health agencies or clients' homes, and $65.00 across all settings.