J0738 Medicaid reimbursement rates by state
Injection, lenacapavir, 1 mg, fda approved prescription. 33 state Medicaid programs publish a fee-for-service rate for J0738 at the physician psychologist level. Rates run from $13.94 in Idaho to $20.54 in California, with a median of $16.02.
Data as of 2026-10-05. Every rate links to the official document it came from.
- States publishing
- 33
- Median rate
- $16.02units vary by state
- Highest
- $20.54California
- Medicare (non-facility)
- —not on the physician fee schedule
J0738 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 |
|---|---|---|---|---|---|---|
| CaliforniaAny qualified provider (rate does not vary by provider) · California Medi-Cal (fee-for-service) | $20.54since 2026-07-01 | — | — | Plans negotiate; applies out of network | — | Medi-Cal Physician-Administered Drug Rat |
| MarylandAny qualified provider (rate does not vary by provider) · Maryland Medicaid (fee-for-service, MDH) | $16.13since 2026-01-01 | — | — | Not classified | — | Maryland Medicaid Professional Services |
| ConnecticutAny qualified provider (rate does not vary by provider) · Connecticut Medicaid / HUSKY Health (fee-for-service, CMAP) | $16.13since 2026-01-01 | — | — | Not classified | — | CMAP fee schedule: Physician Office and |
| ArkansasAny qualified provider (rate does not vary by provider) · Arkansas Medicaid (fee-for-service) | $16.13since 2025-12-01 | — | — | Not classified | — | Arkansas Medicaid Nurse Practitioner Fee |
| MississippiAny qualified provider (rate does not vary by provider) · Mississippi Medicaid (fee-for-service) | $16.10since 2026-07-01 | — | — | Plans must pay at least this | — | DOM Comprehensive Fee Schedule, Septembe |
| AlabamaAny qualified provider (rate does not vary by provider) · Alabama Medicaid (fee-for-service, Alabama Medicaid Agency fee schedules) | $16.10since 2026-08-25 | — | — | Not classified | — | Physician Drug Fee Schedule (REF-0130-Q) |
| Rhode IslandAny qualified provider (rate does not vary by provider) · Rhode Island Medicaid (fee-for-service) | $16.08since 2026-07-01 | — | — | Plans negotiate; applies out of network | — | RI Medicaid Interactive Fee For Service |
| MontanaAny qualified provider (rate does not vary by provider) · Montana Medicaid and HMK Plus (fee-for-service) | $16.08since 2026-07-01 | — | — | Not classified | — | Montana Healthcare Programs fee schedule |
| North CarolinaAny qualified provider (rate does not vary by provider) · North Carolina Medicaid Direct (fee-for-service) | $16.08since 2026-08-01 | — | — | Plans negotiate; applies out of network | — | NC Medicaid fee schedule 'Physician Admi |
| NebraskaAny qualified provider (rate does not vary by provider) · Nebraska Medicaid (fee-for-service) | $16.08since 2026-07-01 | — | — | Plans negotiate; applies out of network | — | Nebraska Medicaid fee schedule 471-000-5 |
| MichiganAny qualified provider (rate does not vary by provider) · Michigan Medicaid (fee-for-service) | $16.08since 2026-07-01 | — | — | Plans negotiate; applies out of network | — | MDHHS Certified Nurse Midwife Fee Schedu |
| MinnesotaAny qualified provider (rate does not vary by provider) · Minnesota Health Care Programs: Medical Assistance (fee-for-service) | $16.08since 2026-07-01 | — | — | Plans negotiate; applies out of network | — | MHCP Fee Schedule - Current Fee Schedule |
| VirginiaAny qualified provider (rate does not vary by provider) · Virginia Medicaid (fee-for-service, DMAS) | $16.08since 2026-07-01 | — | — | 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) | $16.08since 2026-07-01 | — | — | State sets the plan rate | — | SoonerCare Title XIX Fee Schedule |
| NevadaPhysician or licensed psychologist (incl. BCBA-D) · Nevada Medicaid (fee-for-service provider-type reimbursement schedules) | $16.08since 2026-09-01 | — | — | Plans must pay at least this | — | Physician Administered Drug (PAD) Pricin |
| MaineAny qualified provider (rate does not vary by provider) · MaineCare (fee-for-service) | $16.08since 2026-07-01 | — | — | Not classified | — | MaineCare Fee Schedule (MaineCare UCR, H |
| UtahAny qualified provider (rate does not vary by provider) · Utah Medicaid (fee-for-service, Traditional plan) | $16.02since 2026-10-01 | — | — | Plans negotiate; applies out of network | — | Utah Medicaid Coverage and Reimbursement |
| GeorgiaAny qualified provider (rate does not vary by provider) · Georgia Medicaid (fee-for-service) | $16.02since 2026-10-01 | — | — | Plans negotiate; applies out of network | — | PADL Fee Schedule -Published Copy - Octo |
| OhioAny qualified provider (rate does not vary by provider) · Ohio Medicaid (fee-for-service) | $16.02since 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 | $16.02since 2026-10-01 | — | — | Plans negotiate; applies out of network | — | HCA Professional administered drugs fee |
| WisconsinAny qualified provider (rate does not vary by provider) · Wisconsin Medicaid and BadgerCare Plus (fee-for-service, ForwardHealth maximum allowable fees) | $16.02since 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 (KMAP fee-for-service schedule) | $16.02since 2026-10-01 | — | — | Plans must pay at least this | — | KMAP Fee Schedule TXIX Medicaid (FeeSche |
| South DakotaAny qualified provider (rate does not vary by provider) · South Dakota Medicaid (fee-for-service, DSS Division of Medical Services) | $16.02since 2026-10-01 | — | — | Not classified | — | South Dakota Medicaid Drugs and Biologic |
| West VirginiaAny qualified provider (rate does not vary by provider) · West Virginia Medicaid (fee-for-service, Bureau for Medical Services) | $16.02since 2026-10-01 | 1 MG | — | Plans negotiate; applies out of network | — | BMS Physician Administered Drug ASP Pric |
| IndianaAny qualified provider (rate does not vary by provider) · Indiana Medicaid (fee-for-service) | $15.98since 2025-10-01 | unit | — | Plans must pay at least this | — | IHCP Professional Fee Schedule (Last Upd |
| IllinoisAny qualified provider (rate does not vary by provider) · Illinois Medicaid (HFS fee-for-service) | $15.67since 2026-04-01 | — | — | Plans negotiate; applies out of network | — | HFS Practitioner Fee Schedule (effective |
| TexasPhysician or licensed psychologist (incl. BCBA-D) · Texas Medicaid (fee-for-service, TMHP) | $15.52since 2026-09-01 | — | — | Plans negotiate; applies out of network | — | TMHP Texas Medicaid Fee Schedule - Physi |
| ColoradoAny qualified provider (rate does not vary by provider) · Health First Colorado (Colorado Medicaid, fee-for-service) | $15.49since 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) | $15.33since 2026-04-01 | — | — | Not classified | — | Vermont Medicaid Fee Schedule - HCPCS (i |
| New HampshireAny qualified provider (rate does not vary by provider) · New Hampshire Medicaid (fee-for-service, DHHS / NH MMIS) | $15.22since 2025-10-01 | — | — | Plans negotiate; applies out of network | — | 2026 Fee Schedule - Covered Procedures R |
| New JerseyAny qualified provider (rate does not vary by provider) · New Jersey Medicaid / NJ FamilyCare (fee-for-service) | $15.08since 2026-01-01 | — | — | Not classified | — | NJMMIS Procedure Master Listing CPTHCPCS |
| ArizonaAny qualified provider (rate does not vary by provider) · Arizona AHCCCS fee-for-service (AIHP, Tribal ALTCS, TRBHA and other FFS members) | $14.47since 2026-08-01 | — | — | Plans negotiate; applies out of network | — | AHCCCS FFS Capped Fee Schedule: Physicia |
| IdahoAny qualified provider (rate does not vary by provider) · Idaho Medicaid (fee-for-service, Division of Medicaid / Gainwell) | $13.94since 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 J0738?
It depends on the state. Of the 33 states with a published fee-for-service rate, the median is $16.02. California pays the most ($20.54) and Idaho the least ($13.94).
Which state pays the highest Medicaid rate for J0738?
California, at $20.54, effective 2026-07-01.
Do managed-care plans pay the same rate for J0738?
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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Track J0738 in your statesYour codes on one rate card: every payer's rule, Medicare comparison, rank and rate changes.