J0604 Medicaid reimbursement rates by state
Cinacalcet, oral, 1 mg, (for esrd on dialysis). 8 state Medicaid programs publish a fee-for-service rate for J0604 at the physician psychologist level. Rates run from $0.01 in Washington to $0.84 in South Carolina, with a median of $0.02.
Data as of 2026-10-05. Every rate links to the official document it came from.
- States publishing
- 8
- Median rate
- $0.02units vary by state
- Highest
- $0.84South Carolina
- Medicare (non-facility)
- —not on the physician fee schedule
J0604 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 |
|---|---|---|---|---|---|---|
| South CarolinaAny qualified provider (rate does not vary by provider) · South Carolina Healthy Connections Medicaid (fee-for-service) | $0.84⚠ over 3× mediansince 2023-01-01 | — | — | Not classified | — | SCDHHS Infusion Center Fee Schedule (sch |
| OhioAny qualified provider (rate does not vary by provider) · Ohio Medicaid (fee-for-service) | $0.09⚠ over 3× mediansince 2020-10-01 | — | — | Plans negotiate; applies out of network | — | ODM provider-administered pharmaceutical |
| IowaPhysician or licensed psychologist (incl. BCBA-D) · Iowa Medicaid (fee-for-service schedules; the floor IA Health Link plans must pay) | $0.03since 2024-03-01 | — | — | Plans must pay at least this | — | Iowa Medicaid fee schedule #02 PHYSICIAN |
| ArizonaAny qualified provider (rate does not vary by provider) · Arizona AHCCCS fee-for-service (AIHP, Tribal ALTCS, TRBHA and other FFS members) | $0.02since 2026-08-01 | — | — | Plans negotiate; applies out of network | — | AHCCCS FFS Capped Fee Schedule: Physicia |
| NebraskaAny qualified provider (rate does not vary by provider) · Nebraska Medicaid (fee-for-service) | $0.02since 2026-07-01 | — | — | Plans negotiate; applies out of network | — | Nebraska Medicaid fee schedule 471-000-5 |
| CaliforniaAny qualified provider (rate does not vary by provider) · California Medi-Cal (fee-for-service) | $0.01since 2026-04-01 | — | — | Plans negotiate; applies out of network | — | Medi Cal Physician Administered Drug Rat |
| MassachusettsAny qualified provider (rate does not vary by provider) · MassHealth (fee-for-service, EOHHS 101 CMR rate regulations) | $0.01since 2026-07-17 | — | — | Plans negotiate; applies out of network | — | Rates for Dialysis Treatments and Home D |
| WashingtonAny qualified provider (rate does not vary by provider) · Washington Apple Health (Medicaid) fee-for-service | $0.01since 2026-07-01 | — | — | Plans negotiate; applies out of network | — | HCA Kidney centers fee schedule (kidneyc |
Rates marked ⚠ are more than three times the median for the same unit; they are published as shown but often reflect an office (non-facility) fee or a different scope of service. 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 J0604?
It depends on the state. Of the 8 states with a published fee-for-service rate, the median is $0.02. South Carolina pays the most ($0.84) and Washington the least ($0.01).
Which state pays the highest Medicaid rate for J0604?
South Carolina, at $0.84, effective 2023-01-01.
Do managed-care plans pay the same rate for J0604?
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.