Yes, most home health nurses do get paid mileage between patient visits, but there is no federal law forcing an agency to pay a specific cents-per-mile rate. Federal law requires your employer to pay you for the time you spend driving between patients, not to reimburse the wear and tear on your car. Many agencies voluntarily reimburse at or near the IRS standard business mileage rate, which is 72.5 cents per mile for 2026, up from 70 cents in 2025.1Internal Revenue Service. Notice 2026-10: 2026 Standard Mileage Rates Whether you actually get paid, and how much, comes down to your employment contract, your state, and whether you work as a W-2 employee or a 1099 contractor.
What Federal Law Actually Requires
Under the Fair Labor Standards Act, time you spend driving from one patient’s home to the next during your workday counts as hours worked and must be paid at your regular rate.2eCFR. 29 CFR Part 785 Subpart C – Traveltime That travel time also counts toward the 40-hour weekly threshold for overtime, so if driving pushes you past 40 hours your employer owes time-and-a-half for those extra hours.3U.S. Department of Labor. Fact Sheet #22: Hours Worked Under the Fair Labor Standards Act (FLSA)
The one federal backstop on vehicle costs is the minimum wage floor. If unreimbursed driving expenses effectively push your earnings below $7.25 per hour in a workweek, that’s an FLSA violation. A Department of Labor opinion letter identifies required use of a personal vehicle as a cost that cannot cut into minimum wage or overtime pay.4Department of Labor. Wage and Hour Division Opinion Letter FLSA 2020-08-31 Home health nurses usually earn well above minimum wage, so this protection rarely kicks in, but nurses who drive heavy mileage in expensive metro areas with zero reimbursement should run the numbers.
Commute Miles Versus Between-Patient Miles
Not every mile you drive during the workday is treated the same. The trip from your home to your first patient and the drive from your last patient back home count as ordinary commuting. Federal regulations classify that travel as non-compensable, even when your first stop changes every day.5eCFR. 29 CFR 785.35 – Home to Work; Ordinary Situation
Everything in between is different. Once you leave your first patient’s home headed to your second appointment, you’re traveling as part of your principal work activity. That driving time must be paid, and those miles are what most agency reimbursement policies actually cover. Keep your logs focused on inter-visit trips; the commute at either end almost never generates reimbursement unless your contract specifically includes it.
How Much Agencies Typically Pay
The IRS calculates the annual standard mileage rate based on a study of the fixed and variable costs of operating a car, including depreciation, insurance, fuel, maintenance, and repairs. The 2026 rate of 72.5 cents per mile applies equally to gasoline, diesel, hybrid, and fully electric vehicles.6Internal Revenue Service. IRS Sets 2026 Business Standard Mileage Rate
Many agencies peg their reimbursement to this rate, but they aren’t required to match it. Some pay the full 72.5 cents. Others reimburse at a lower flat cents-per-mile rate, and some substitute a fixed monthly car allowance regardless of miles driven. The IRS rate matters most as a tax benchmark: reimbursements at or below it are generally tax-free to you, while amounts above it may be treated as wages.
How Reimbursements Are Taxed
How mileage payments show up on your tax return depends on whether your agency runs what the IRS calls an “accountable plan.” Under an accountable plan, reimbursements aren’t taxable income and won’t appear in Box 1 of your W-2. To qualify, the plan must meet three requirements: the expense must have a business connection, you must substantiate it to your employer within a reasonable time, and you must return any excess payment.7eCFR. 26 CFR 1.62-2 – Reimbursements and Other Expense Allowance Arrangements
When an accountable plan reimburses above the IRS standard rate, the portion up to 72.5 cents per mile stays tax-free and the excess gets reported as wages. Reimbursements at or below the standard rate, with proper documentation, are fully excluded from your taxable income.8Internal Revenue Service. Publication 463 (2025), Travel, Gift, and Car Expenses
Arrangements that don’t meet those rules are “nonaccountable plans.” The employer lumps the payment in with your regular wages, reports the full amount in Box 1, and you owe income tax and payroll tax on all of it. A flat monthly car allowance that doesn’t require you to log actual miles is almost always nonaccountable. If your agency hands you $300 a month regardless of how much you drive, that money will be taxed as wages.
Why You Can’t Deduct the Shortfall on Your Taxes
If your employer reimburses nothing, or pays well below the IRS rate, you might assume you can claim the difference on your federal return. You can’t. The Tax Cuts and Jobs Act eliminated the deduction for unreimbursed employee business expenses starting in 2018, and the One Big Beautiful Bill Act of 2025 made that elimination permanent.9Office of the Law Revision Counsel. 26 U.S. Code 67 – 2-Percent Floor on Miscellaneous Itemized Deductions W-2 nurses have no route to recover unreimbursed mileage through their tax return.
That makes your agency’s reimbursement policy the single biggest factor in your actual take-home pay as a mobile nurse. A nurse driving 100 miles a day between patients with no reimbursement is absorbing over $70 in daily vehicle costs with no offset. Negotiating mileage at the hiring stage matters more than it ever has.
Different Rules for 1099 Contractors
Nurses working as independent contractors on a 1099 basis have a completely different tax situation. As a self-employed nurse, you report income and expenses on Schedule C and deduct business mileage directly against your earnings. For 2026, that’s 72.5 cents for every business mile driven, plus parking fees and tolls.10Internal Revenue Service. Instructions for Schedule C (Form 1040)
You can use the standard mileage rate if you owned the vehicle and used this method the first year you placed it in service, or if you leased it and have used the standard rate for the entire lease. The alternative is tracking actual expenses (fuel, insurance, repairs, depreciation) and deducting the business-use percentage. Most nurses find the standard rate simpler and often more generous unless they drive a very inexpensive vehicle.
The tradeoff: contractors don’t get FLSA protections. No one owes you minimum wage, overtime, or travel-time pay, and you cover your own self-employment taxes. The mileage deduction is your primary tool for recouping driving costs, so meticulous logs are non-negotiable.
State Laws and Your Employment Contract
A handful of states go further than federal law by requiring employers to reimburse employees for necessary work-related expenses, including vehicle mileage. As of 2025, at least three states mandate that employers cover travel expenses when employees use personal vehicles for work. In those states, the reimbursement obligation applies regardless of whether your pay stays above minimum wage. Check your state labor department’s website to see whether yours is one of them.
Even where no state mandate exists, many agencies reimburse voluntarily because they need to recruit and retain mobile nurses. If your offer letter or employee handbook includes a mileage reimbursement policy, that language can become an enforceable part of your employment agreement. Read it carefully and keep a copy.
Keeping Records That Hold Up
Whether you’re tracking miles for employer reimbursement or a Schedule C deduction, weak logs are the fastest way to lose money. Every trip between patients needs a recorded starting point, destination, odometer reading, date, and business purpose. Use a patient identifier rather than a full name to stay consistent with privacy rules. The IRS expects contemporaneous records, meaning you log each trip the day it happens rather than reconstructing a month’s worth from memory. A mileage-tracking app that uses GPS to record routes automatically is the easiest way to meet that standard.
What to Do If Reimbursement Falls Short
If your employer pays nothing or reimburses well below the IRS rate, you have a few options. Calculate whether your out-of-pocket vehicle costs are dragging your effective hourly wage below $7.25 in any workweek. If they are, that’s a potential FLSA violation you can report to the Department of Labor’s Wage and Hour Division.11U.S. Department of Labor. Fact Sheet #16: Deductions From Wages for Uniforms and Other Facilities Under the Fair Labor Standards Act (FLSA)
Check whether your state has an expense-reimbursement law that goes beyond the federal minimum wage floor. Review your employment contract and handbook: a written mileage policy your employer ignores may support a breach-of-contract claim. And if you’re negotiating a new position, treat mileage reimbursement as a compensation item alongside salary and health benefits. The difference between 72.5 cents per mile and zero reimbursement on 20,000 business miles a year is over $14,000 out of your pocket.