J0220 Medicaid reimbursement rates by state
Injection, alglucosidase alfa, 10 mg. 17 state Medicaid programs publish a fee-for-service rate for J0220 at the physician psychologist level. Rates run from $121.40 in North Carolina to $219.10 in New Mexico, with a median of $202.65.
Data as of 2026-10-05. Every rate links to the official document it came from.
- States publishing
- 17
- Median rate
- $202.65units vary by state
- Highest
- $219.10New Mexico
- Medicare (non-facility)
- —not on the physician fee schedule
J0220 rate in every state
One like-for-like fee-for-service rate per state, highest first. Units can differ between states; the per-hour column converts time-based units.
| State | Medicaid rate | Unit | Per hour | Managed-care plans | % of Medicare | Source |
|---|---|---|---|---|---|---|
| New MexicoAny qualified provider (rate does not vary by provider) · New Mexico Medicaid (fee-for-service, HCA Medical Assistance Division) | $219.10since 2025-01-01 | — | — | Plans must pay at least this | — | New Mexico Medicaid Fee for Service HCPC |
| South CarolinaAny qualified provider (rate does not vary by provider) · South Carolina Healthy Connections Medicaid (fee-for-service) | $214.50since 2016-07-01 | — | — | Not classified | — | SCDHHS Infusion Center Fee Schedule (sch |
| CaliforniaAny qualified provider (rate does not vary by provider) · California Medi-Cal (fee-for-service) | $211.10since 2026-10-01 | — | — | Plans negotiate; applies out of network | — | Medi-Cal Rates (Rates files zip: rates_d |
| OhioAny qualified provider (rate does not vary by provider) · Ohio Medicaid (fee-for-service) | $206.70since 2016-02-01 | — | — | Plans negotiate; applies out of network | — | ODM provider-administered pharmaceutical |
| MichiganAny qualified provider (rate does not vary by provider) · Michigan Medicaid (fee-for-service) | $206.70since 2023-01-01 | — | — | Plans negotiate; applies out of network | — | MDHHS Practitioner and Medical Clinic Fe |
| WisconsinAny qualified provider (rate does not vary by provider) · Wisconsin Medicaid and BadgerCare Plus (fee-for-service, ForwardHealth maximum allowable fees) | $206.70since 2016-01-01 | — | — | Plans negotiate; applies out of network | — | ForwardHealth max fee schedule: Medical- |
| MarylandAny qualified provider (rate does not vary by provider) · Maryland Medicaid (fee-for-service, MDH) | $206.64since 2026-01-01 | — | — | Not classified | — | Maryland Medicaid Professional Services |
| VirginiaAny qualified provider (rate does not vary by provider) · Virginia Medicaid (fee-for-service, DMAS) | $206.09since 2013-07-01 | — | — | Plans negotiate; applies out of network | — | DMAS procedure fee file hcpcmedical.csv |
| OklahomaAny qualified provider (rate does not vary by provider) · Oklahoma SoonerCare (fee-for-service, OHCA) | $202.65since 2026-07-01 | — | — | State sets the plan rate | — | SoonerCare Title XIX Fee Schedule |
| AlabamaAny qualified provider (rate does not vary by provider) · Alabama Medicaid (fee-for-service, Alabama Medicaid Agency fee schedules) | $198.67since 2026-08-25 | — | — | Not classified | — | Physician Drug Fee Schedule (REF-0130-Q) |
| GeorgiaAny qualified provider (rate does not vary by provider) · Georgia Medicaid (fee-for-service) | $195.00since 2017-10-01 | — | — | Plans negotiate; applies out of network | — | PADL_ Appendix A_ Schedule of Maximum Al |
| ArizonaAny qualified provider (rate does not vary by provider) · Arizona AHCCCS fee-for-service (AIHP, Tribal ALTCS, TRBHA and other FFS members) | $181.46since 2024-04-01 | — | — | Plans negotiate; applies out of network | — | AHCCCS FFS Capped Fee Schedule: Physicia |
| KansasAny qualified provider (rate does not vary by provider) · Kansas Medicaid QMB (Qualified Medicare Beneficiary) KMAP fee schedule | $168.13since 2021-04-01 | — | — | Not classified | — | KMAP Fee Schedule QMB Medicaid (FeeSched |
| New JerseyAny qualified provider (rate does not vary by provider) · New Jersey Medicaid / NJ FamilyCare (fee-for-service) | $131.25since 2025-01-01 | — | — | Not classified | — | NJMMIS Procedure Master Listing CPTHCPCS |
| IowaPhysician or licensed psychologist (incl. BCBA-D) · Iowa Medicaid (fee-for-service schedules; the floor IA Health Link plans must pay) | $128.20since 2021-10-01 | — | — | Plans must pay at least this | — | Iowa Medicaid fee schedule #02 PHYSICIAN |
| ArkansasPhysician or licensed psychologist (incl. BCBA-D) · Arkansas Medicaid (fee-for-service) | $127.20since 2025-06-13 | — | — | Not classified | — | Arkansas Medicaid Physician / CRNA / Fam |
| North CarolinaAny qualified provider (rate does not vary by provider) · North Carolina Medicaid Direct (fee-for-service) | $121.40since 2022-01-01 | — | — | Plans negotiate; applies out of network | — | NC Medicaid fee schedule 'Ambulatory Inf |
Rates are per the unit shown for each state; units can differ between states. Medicare amounts are computed from the CMS relative value file and locality cost indices with the CMS formula; states with several Medicare localities show a range. Confirm rates with the payer before billing.
Frequently asked questions
What does Medicaid pay for J0220?
It depends on the state. Of the 17 states with a published fee-for-service rate, the median is $202.65. New Mexico pays the most ($219.10) and North Carolina the least ($121.40).
Which state pays the highest Medicaid rate for J0220?
New Mexico, at $219.10, effective 2025-01-01.
Do managed-care plans pay the same rate for J0220?
Not necessarily. Each state's plan contracts decide whether plans must pay at least the fee-for-service rate, pay a state-set rate, or negotiate their own. The table shows the rule for each state, cited to the contract or statute.
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