Home health clinicians spend a large share of the day in a car. The first question about a per-visit job is the rate. The second should be what happens to the drive. Federal wage rules say something about it, but only for employees, and only in part. The rest is agency practice.
This page separates the two. It covers what the federal hours-worked rules say about travel, what the IRS mileage rate is and is not, and what to ask before taking a per-visit offer. It is for clinicians comparing offers and for agency owners writing a pay policy. It is not legal advice, and it does not decide whether a given clinician is an employee or a contractor.
The federal quotations are from 29 CFR Parts 531, 778 and 785, read on Cornell LII. The mileage figures are from the IRS.
Is Drive Time Hours Worked?
For an employee, travel between patients is work. The rule is 29 CFR 785.38:
"Time spent by an employee in travel as part of his principal activity, such as travel from job site to job site during the workday, must be counted as hours worked."
In home health, each patient's home is a job site. The drive from visit one to visit two is part of the workday. The rule has no exception for pay structure. A flat sum per visit does not turn the drive into unpaid time.
The same regulation also covers the end of the day:
"However, if the employee goes home instead of returning to his employer's premises, the travel after 8 p.m. is home-to-work travel and is not hours worked."
The 8 p.m. belongs to the regulation's example. The principle is that travel from the last job straight home is commuting.
Is the Commute to the First Patient Paid?
Usually not. 29 CFR 785.35 reads:
"An employee who travels from home before his regular workday and returns to his home at the end of the workday is engaged in ordinary home to work travel which is a normal incident of employment. This is true whether he works at a fixed location or at different job sites. Normal travel from home to work is not worktime."
The phrase "at different job sites" is the one clinicians miss. Driving from home to the first patient's door is a commute even though the destination changes every day.
Where the line moves is the "ordinary situation" in the section title. The other part of 785.38 says that if an employee must report to a meeting place "to receive instructions or to perform other work there," the travel from that place to the work site is part of the day's work. A clinician required to stop at the office to pick up supplies or paperwork before the first visit is in that second situation. The drive after the stop counts.
These rules apply to employees. The sections quoted say "employee" throughout. A contractor is not covered by them, and the line between the two is its own legal question.
What a Per-Visit Rate Does to Overtime
Per-visit pay is a flat sum for a unit of work. The overtime regulation for that case is 29 CFR 778.112, titled "Day rates and job rates":
"If the employee is paid a flat sum for a day's work or for doing a particular job, without regard to the number of hours worked in the day or at the job, and if he receives no other form of compensation for services, his regular rate is determined by totaling all the sums received at such day rates or job rates in the workweek and dividing by the total hours actually worked. He is then entitled to extra half-time pay at this rate for all hours worked in excess of 40 in the workweek."
Read that with the travel rule above. The hours that go into "total hours actually worked" include the drive between patients. A clinician with 28 visits in a week has driven between most of them, and those hours count in the total.
This is a reading of the plain words, not a ruling on any agency's plan. It covers non-exempt employees. Whether a salaried or fee-paid clinician is exempt from overtime depends on other rules not covered here.
Can Your Own Car Cut Into Pay?
The "free and clear" rule is 29 CFR 531.35:
"The wage requirements of the Act will not be met where the employee 'kicks-back' directly or indirectly to the employer or to another person for the employer's benefit the whole or part of the wage delivered to the employee."
Its example is about tools:
"For example, if it is a requirement of the employer that the employee must provide tools of the trade which will be used in or are specifically required for the performance of the employer's particular work, there would be a violation of the Act in any workweek when the cost of such tools purchased by the employee cuts into the minimum or overtime wages required to be paid him under the Act."
The regulation does not say "vehicle." Applying it to a clinician's car, gas and wear is an argument by analogy, and this page did not fetch a Department of Labor position on vehicles. The practical point still holds. When the job requires you to drive your own car to every patient and the agency pays no mileage, the car is a cost of the work. In a week where pay is close to the minimum, that cost is what the rule is about.
The check is simple. Take the week's pay, subtract what the work miles cost you, and divide by all hours worked, drive included. If the answer is near the minimum wage, the rate needs a second look.
What the IRS Mileage Rate Is
The IRS publishes a standard mileage rate each year. Notice 2026-10 sets the 2026 business rate:
"The standard mileage rate for transportation or travel expenses for 2026 is 72.5 cents per mile for all miles of business use (business standard mileage rate)."
The IRS later raised it for the second half of the year. Its standard mileage rates page lists "2026 (July 1 to Dec. 31)" as "Self-employed and business: 76 cents/mile" and "2026 (Jan. 1 to June 30)" as 72.5.
| Period | IRS business rate |
|---|---|
| January 1 to June 30, 2026 | 72.5 cents per mile |
| July 1 to December 31, 2026 | 76 cents per mile |
Two things this rate is not. It is not a wage rule, and nothing in the federal hours-worked sections above ties pay to it. It also does not help most employees on their own tax return. The notice says:
"Thus, the business standard mileage rate provided in this notice cannot be used to claim an itemized deduction for unreimbursed employee travel expenses, except for certain educator expenses as described later."
The notice names a few groups that can still deduct, and clinicians are not among them. For a W-2 clinician, miles the agency does not reimburse are miles nobody pays for. Settle the question before the first day.
Info
Practice, not rule: an agency may tie mileage to the IRS rate because it is a number both sides can look up. No federal rule requires it. This page has no cited survey of what agencies pay, so it does not say what is typical. Ask.
A State Example: California
Some states add their own rule. California is the one most often cited. Labor Code section 2802(a), reproduced in the state Division of Labor Standards Enforcement's wage publication:
"An employer shall indemnify his or her employee for all necessary expenditures or losses incurred by the employee in direct consequence of the discharge of his or her duties, or of his or her obedience to the directions of the employer, even though unlawful, unless the employee, at the time of obeying the directions, believed them to be unlawful."
This is state law. It applies to California employees, and it does not name mileage or a rate. Other states have their own rules or none. A clinician or an agency outside California should read the labor code and agency guidance for that state, and should not assume this one applies.
Questions to Ask Before You Accept a Per-Visit Job
Nothing below is a legal requirement. It is what a clinician can ask so the rate means something. Get the answers in writing.
| Ask | Why it matters |
|---|---|
| Employee or contractor? | The hours-worked rules above protect employees. Settle this first. |
| Is drive time between visits paid, and how? | Under 785.38 it is hours worked for an employee. A per-visit rate may be meant to cover it. Ask whether it does. |
| What is the mileage rate, and where does it start? | From home, from the first visit, or from the office are three different payments. |
| What happens on a cancelled or missed visit? | The drive happened. Whether the visit pays is policy. |
| Is documentation time paid? | A per-visit rate usually has to cover charting. |
| Is there a guaranteed minimum or a paid orientation? | Early weeks run below a full caseload. See reduce clinician turnover. |
| How are routes set? | A tight route is worth more than a high rate. See home health scheduling. |
For dollar figures, see home health pay per visit by state, built from 2024 Medicare cost reports. It notes that mileage and drive time are paid at some agencies and not others, and none of that is in the visit count.
For Agencies Writing a Pay Policy
- Count the hours. For employees, travel between patients goes into hours worked. A per-visit rate is a way of paying for hours, not of not counting them.
- Keep the overtime math. Under 778.112 the regular rate is total pay divided by total hours, drive included.
- Write the commute line down. Say whether a required office stop is part of the day, because the leg after it is.
- Publish a mileage rule. Practice, not rule: pick a number that can be looked up, and say where the count starts.
See the numbers for your county
Pick your discipline and ZIP code. The calculator shows what agencies near you spent per visit, and turns a per-visit rate into weekly and yearly pay.
Key Takeaways
- For employees, travel from job site to job site during the workday is hours worked (29 CFR 785.38). Paying per visit does not change that.
- Home to the first patient and the last patient to home is ordinarily a commute and not worktime (29 CFR 785.35).
- Per-visit pay is a flat sum. For overtime the regular rate is total pay divided by all hours actually worked, drive time included (29 CFR 778.112).
- The IRS business rate is 72.5 cents a mile through June 30, 2026 and 76 cents from July 1. It is a tax figure, not a reimbursement rule, and unreimbursed employee mileage cannot be itemized federally.
- Everything else, including whether miles are paid and at what rate, is practice, not rule, unless a state law like California Labor Code 2802 says otherwise. Ask and get it in writing.
Frequently asked questions
Do home health agencies have to pay for drive time between patients?
For employees, federal wage rules say yes. 29 CFR 785.38 says travel from job site to job site during the workday must be counted as hours worked. Paying per visit does not change that. The drive from home to the first patient and from the last patient to home is ordinarily not worktime.
Is the IRS mileage rate the amount an agency must reimburse?
No. The IRS rate is a tax figure. Federal law does not set a reimbursement rate for home health. For July 1 to December 31, 2026 the IRS business rate is 76 cents a mile, and it was 72.5 cents from January 1 to June 30. Many agencies use it as a benchmark, but that is practice, not rule.
Can a per-visit pay rate drop below minimum wage?
It can. A flat sum per visit still has to cover every hour worked, including drive time between patients, and the rule on free and clear payment suggests an employee's own vehicle costs can cut into required wages. Add up the hours and the unreimbursed miles for a real week before judging a rate.
Does California require mileage reimbursement?
California Labor Code 2802 requires an employer to indemnify an employee for all necessary expenditures or losses incurred in direct consequence of the discharge of the employee's duties. That is state law and applies to employees working in California. Other states differ, so check yours.
What should a clinician ask about mileage and drive time before accepting a per-visit job?
Ask whether you are an employee or a contractor, whether drive time between visits is paid, what the mileage rate is and from which point it starts, whether missed and cancelled visits are paid, and whether documentation time is paid. Get the answers in writing.
Sources
- 29 CFR 785.38, travel that is all in the day's work.
- 29 CFR 785.35, home to work, ordinary situation.
- 29 CFR 778.112, day rates and job rates, and 29 CFR 778.111, pieceworker.
- 29 CFR 531.35, "free and clear" payment and "kickbacks."
- IRS, Notice 2026-10, 2026 Standard Mileage Rates, and the IRS standard mileage rates page for the July 1 to December 31, 2026 rate.
- California Division of Labor Standards Enforcement, The Laws Relating to the Time, Manner and Payment of Wages (rev. October 2013), reproducing Labor Code section 2802. Check the current text on leginfo.legislature.ca.gov.
- Related on this site: home health pay per visit by state, reduce clinician turnover, home health scheduling guide.