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J0485 Medicaid reimbursement rates by state

Injection, belatacept, 1 mg. 35 state Medicaid programs publish a fee-for-service rate for J0485 at the physician psychologist level. Rates run from $3.36 in Idaho to $4.35 in Utah, with a median of $3.89.

Data as of 2026-10-05. Every rate links to the official document it came from.

States publishing
35
Median rate
$3.89units vary by state
Highest
$4.35Utah
Medicare (non-facility)
—not on the physician fee schedule

J0485 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.

StateMedicaid rateUnitPer hourManaged-care plans% of MedicareSource
UtahAny qualified provider (rate does not vary by provider) · Utah Medicaid (fee-for-service, Traditional plan)$4.35since 2026-10-01——Plans negotiate; applies out of network—Utah Medicaid Coverage and Reimbursement
IndianaAny qualified provider (rate does not vary by provider) · Indiana Medicaid (fee-for-service)$4.07since 2023-10-01unit—Plans must pay at least this—IHCP Professional Fee Schedule (Last Upd
IowaPhysician or licensed psychologist (incl. BCBA-D) · Iowa Medicaid (fee-for-service schedules; the floor IA Health Link plans must pay)$3.93since 2024-05-01——Plans must pay at least this—Iowa Medicaid fee schedule #02 PHYSICIAN
New MexicoAny qualified provider (rate does not vary by provider) · New Mexico Medicaid (fee-for-service, HCA Medical Assistance Division)$3.93since 2025-04-01——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)$3.89since 2025-04-01——Not classified—SCDHHS Infusion Center Fee Schedule (sch
ArizonaAny qualified provider (rate does not vary by provider) · Arizona AHCCCS fee-for-service (AIHP, Tribal ALTCS, TRBHA and other FFS members)$3.89since 2026-08-01——Plans negotiate; applies out of network—AHCCCS FFS Capped Fee Schedule: Physicia
CaliforniaAny qualified provider (rate does not vary by provider) · California Medi-Cal (fee-for-service)$3.89since 2026-10-01——Plans negotiate; applies out of network—Medi-Cal Rates (Rates files zip: rates_d
TexasPhysician or licensed psychologist (incl. BCBA-D) · Texas Medicaid (fee-for-service, TMHP)$3.89since 2026-03-01——Plans negotiate; applies out of network—TMHP Texas Medicaid Fee Schedule - Physi
MichiganAny qualified provider (rate does not vary by provider) · Michigan Medicaid (fee-for-service)$3.89since 2025-04-01——Plans negotiate; applies out of network—MDHHS Practitioner and Medical Clinic Fe
MarylandAny qualified provider (rate does not vary by provider) · Maryland Medicaid (fee-for-service, MDH)$3.89since 2026-01-01——Not classified—Maryland Medicaid Professional Services
AlabamaAny qualified provider (rate does not vary by provider) · Alabama Medicaid (fee-for-service, Alabama Medicaid Agency fee schedules)$3.89since 2026-08-25——Not classified—Physician Drug Fee Schedule (REF-0130-Q)
ConnecticutAny qualified provider (rate does not vary by provider) · Connecticut Medicaid / HUSKY Health (fee-for-service, CMAP)$3.89since 2026-01-01——Not classified—CMAP fee schedule: Physician Office and
OregonAny qualified provider (rate does not vary by provider) · Oregon Health Plan (fee-for-service, OHA)$3.89since 2025-04-01——Plans negotiate; applies out of network—OHP FFS medical-dental fee schedule (fee
OklahomaAny qualified provider (rate does not vary by provider) · Oklahoma SoonerCare (fee-for-service, OHCA)$3.89since 2025-07-01——State sets the plan rate—SoonerCare Title XIX Fee Schedule
MississippiAny qualified provider (rate does not vary by provider) · Mississippi Medicaid (fee-for-service)$3.89since 2025-07-01——Plans must pay at least this—DOM Comprehensive Fee Schedule, Septembe
NevadaPhysician or licensed psychologist (incl. BCBA-D) · Nevada Medicaid (fee-for-service provider-type reimbursement schedules)$3.89since 2025-05-01——Plans must pay at least this—Physician Administered Drug (PAD) Pricin
MaineAny qualified provider (rate does not vary by provider) · MaineCare (fee-for-service)$3.89since 2025-04-01——Not classified—MaineCare Fee Schedule (MaineCare UCR, H
MontanaAny qualified provider (rate does not vary by provider) · Montana Medicaid and HMK Plus (fee-for-service)$3.89since 2025-04-01——Not classified—Montana Healthcare Programs fee schedule
West VirginiaAny qualified provider (rate does not vary by provider) · West Virginia Medicaid (fee-for-service, Bureau for Medical Services)$3.88since 2026-10-011 MG—Plans negotiate; applies out of network—BMS Physician Administered Drug ASP Pric
North CarolinaAny qualified provider (rate does not vary by provider) · North Carolina Medicaid Direct (fee-for-service)$3.88since 2026-08-01——Plans negotiate; applies out of network—NC Medicaid fee schedule 'Physician Admi
GeorgiaAny qualified provider (rate does not vary by provider) · Georgia Medicaid (fee-for-service)$3.88since 2026-10-01——Plans negotiate; applies out of network—PADL Fee Schedule -Published Copy - Octo
NebraskaAny qualified provider (rate does not vary by provider) · Nebraska Medicaid (fee-for-service)$3.88since 2026-07-01——Plans negotiate; applies out of network—Nebraska Medicaid fee schedule 471-000-5
OhioAny qualified provider (rate does not vary by provider) · Ohio Medicaid (fee-for-service)$3.88since 2026-10-01——Plans negotiate; applies out of network—ODM provider-administered pharmaceutical
WashingtonAny qualified provider (rate does not vary by provider) · Washington Apple Health (Medicaid) fee-for-service$3.88since 2026-10-01——Plans negotiate; applies out of network—HCA Professional administered drugs fee
MinnesotaAny qualified provider (rate does not vary by provider) · Minnesota Health Care Programs: Medical Assistance (fee-for-service)$3.88since 2025-07-01——Plans negotiate; applies out of network—MHCP Fee Schedule (Wayback capture 20250
VirginiaAny qualified provider (rate does not vary by provider) · Virginia Medicaid (fee-for-service, DMAS)$3.88since 2026-07-01——Plans negotiate; applies out of network—DMAS procedure fee file hcpcmedical.csv
WisconsinAny qualified provider (rate does not vary by provider) · Wisconsin Medicaid and BadgerCare Plus (fee-for-service, ForwardHealth maximum allowable fees)$3.88since 2026-10-01——Plans negotiate; applies out of network—ForwardHealth max fee schedule: Medical-
KansasAny qualified provider (rate does not vary by provider) · Kansas Medicaid QMB (Qualified Medicare Beneficiary) KMAP fee schedule$3.88since 2026-10-01——Not classified—KMAP Fee Schedule QMB Medicaid (FeeSched
New HampshireAny qualified provider (rate does not vary by provider) · New Hampshire Medicaid (fee-for-service, DHHS / NH MMIS)$3.88since 2025-07-01——Plans negotiate; applies out of network—2026 Fee Schedule - Covered Procedures R
ArkansasPhysician or licensed psychologist (incl. BCBA-D) · Arkansas Medicaid (fee-for-service)$3.81since 2025-06-13——Not classified—Arkansas Medicaid Physician / CRNA / Fam
IllinoisAny qualified provider (rate does not vary by provider) · Illinois Medicaid (HFS fee-for-service)$3.79since 2026-04-01——Plans negotiate; applies out of network—HFS Practitioner Fee Schedule (effective
ColoradoAny qualified provider (rate does not vary by provider) · Health First Colorado (Colorado Medicaid, fee-for-service)$3.75since 2026-10-01——Not classified—Q1/Q2/Q3/Q4 2026 PAD Fee Schedule
VermontAny qualified provider (rate does not vary by provider) · Vermont Medicaid (fee-for-service, DVHA)$3.70since 2026-01-01——Not classified—Vermont Medicaid Fee Schedule - HCPCS (i
New JerseyAny qualified provider (rate does not vary by provider) · New Jersey Medicaid / NJ FamilyCare (fee-for-service)$3.66since 2025-01-01——Not classified—NJMMIS Procedure Master Listing CPTHCPCS
IdahoAny qualified provider (rate does not vary by provider) · Idaho Medicaid (fee-for-service, Division of Medicaid / Gainwell)$3.36since 2026-07-01——Not classified—Idaho Medicaid Numerical Fee Schedule Ju

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 J0485?

It depends on the state. Of the 35 states with a published fee-for-service rate, the median is $3.89. Utah pays the most ($4.35) and Idaho the least ($3.36).

Which state pays the highest Medicaid rate for J0485?

Utah, at $4.35, effective 2026-10-01.

Do managed-care plans pay the same rate for J0485?

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.

Related Pharmacy codes

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