Mileage
Home health mileage reimbursement: what you are actually owed.
Your car is part of the equipment and the rules for paying for it are uneven. What is commonly owed, where it is owed by law, how it is usually calculated, and the part nobody reimburses.
Home health is one of the few clinical jobs where the clinician's own car is part of the equipment, and one of the few where the rules about paying for it are this uneven. This page lays out what is commonly owed, where it is owed by law, how the numbers are usually worked out, and the part nobody reimburses.
Three different things people mean by "mileage"
- Reimbursement from your employer. Money the agency pays you per mile driven between patients. Set by the agency's policy, or by state law where one exists.
- The IRS standard mileage rate. A per-mile figure the IRS publishes each December for the coming year. Many agencies use it as their reimbursement rate, but nothing forces them to. For 2025 it was 70 cents a mile; check irs.gov for the current year.
- A tax deduction. Since the 2017 tax law, W-2 employees generally cannot deduct unreimbursed work mileage on a federal return. Independent contractors paid on a 1099 generally can, as a business expense. Some states differ.
Is your agency required to reimburse you?
Under federal law there is no general requirement to reimburse mileage. The one federal backstop is the Fair Labor Standards Act: if unreimbursed driving costs push your effective pay below the minimum wage for the hours worked, that is a wage violation. It rarely bites for nurses; it can for aides on low hourly rates with a lot of driving.
Several states go further and require employers to reimburse necessary business expenses, which courts and agencies have read to include work driving. California's Labor Code section 2802 is the best-known example; Illinois and Massachusetts have comparable provisions, and others have followed or are considering it. If you work in one of those states and are not being reimbursed, that is worth a conversation with your state labor department.
What counts as reimbursable driving
- Between patients: almost always counts.
- From the office to the first patient and from the last patient back: usually counts.
- From home to the first patient: the contested one. Many agencies treat it as a commute and exclude it; some pay it beyond a set radius. Read your policy, because on a rural caseload this can be the largest leg of the day.
- Trips to the pharmacy, lab drop-offs, supply runs: usually count if they are for a patient.
How the reimbursement is usually calculated
| Method | What it means for you |
|---|---|
| Per mile at the IRS rate | The fairest common approach: covers fuel, wear, insurance and depreciation on average. Keep a log. |
| Per mile at a lower agency rate | Legal in most states. The gap between the agency rate and the IRS rate is money you are spending on the job. |
| Flat monthly car allowance | Simple, but it may be taxable income unless structured as an accountable plan, and it does not scale with a heavy week. |
| Per visit, with driving folded in | Common for per-visit pay. Ask what mileage assumption the rate was built on; a rural day can blow through it by ten. |
The part nobody reimburses
Every method above pays for miles driven. None of them pays for miles that a better order of visits would have removed, and none of them gives you back the hour those miles took. If you are paid per visit or on a rate below the IRS figure, that gap is straight out of your pocket. We call it the Windshield Tax, and we built a free calculator so you can see your own number rather than an average.
Keeping a log that holds up
- Date, start and end odometer or start and end address, patient or purpose.
- Record it the same day. A log rebuilt from memory in April is the kind that gets disallowed.
- Keep the first and last legs separate so a policy change does not mean re-doing the year.
- A route that was planned in software gives you the log for free, which is one of the quieter arguments for planning it in software.
Questions people actually ask
What is the IRS mileage rate for home health nurses?
The IRS publishes one standard mileage rate for all business driving, not a special one for home health. It is set each December for the following year; for 2025 it was 70 cents a mile. Check irs.gov for the current figure.
Does my home health agency have to pay mileage?
Federal law does not require it except where unreimbursed costs would push pay below minimum wage. Some states, including California, Illinois and Massachusetts, require employers to reimburse necessary business expenses, which includes work driving.
Can I deduct unreimbursed mileage on my taxes?
If you are a W-2 employee, generally not on a federal return since the 2017 tax law. If you are an independent contractor on a 1099, generally yes as a business expense. State rules vary; ask a tax professional.
Does driving from home to my first patient count?
It depends on your agency's policy. Many treat it as a commute and exclude it, some pay it beyond a set radius. It is often the longest leg of a rural day, so it is worth reading the policy carefully.
How do I keep a mileage log?
Record the date, the start and end addresses or odometer readings, and the patient or purpose, on the same day. Keep home-to-first and last-to-home legs separate. A planned route in software produces the log automatically.
What is the Windshield Tax?
Our name for the miles and hours you spend on a badly ordered route that a better order would have removed. Reimbursement pays for miles driven; nothing pays for miles that need not have been driven. There is a free calculator for your own number.
Obillions
A voice agent for a day of visits. You say what changed and the day re-plans itself: the order, the drive times, and who nearby could take the hour a cancellation just freed. Nothing changes until you confirm, and your voice and photos never leave your phone.
In private testing now. A public TestFlight comes next, then the App Store.