J1170 Medicaid reimbursement rates by state
Injection, hydromorphone, up to 4 mg. 6 state Medicaid programs publish a fee-for-service rate for J1170. Rates run from $1.22 in North Carolina to $6.89 in New Mexico, with a median of $2.70.
Data as of 2026-10-05. Every rate links to the official document it came from.
- States publishing
- 6
- Median rate
- $2.70units vary by state
- Highest
- $6.89New Mexico
- Medicare (non-facility)
- —not on the physician fee schedule
J1170 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) | $6.89since 2025-01-01 | — | — | Plans must pay at least this | — | New Mexico Medicaid Fee for Service HCPC |
| GeorgiaAny qualified provider (rate does not vary by provider) · Georgia Medicaid (fee-for-service) | $3.81since 2024-10-01 | — | — | Plans negotiate; applies out of network | — | Provider's Administered Drug List - Exce |
| CaliforniaAny qualified provider (rate does not vary by provider) · California Medi-Cal (fee-for-service) | $2.70since 2024-07-01 | — | — | Plans negotiate; applies out of network | — | Medi Cal Physician Administered Drug Rat |
| ArizonaAny qualified provider (rate does not vary by provider) · Arizona AHCCCS fee-for-service (AIHP, Tribal ALTCS, TRBHA and other FFS members) | $2.70since 2024-07-01 | — | — | Plans negotiate; applies out of network | — | AHCCCS FFS Capped Fee Schedule: Physicia |
| MichiganAny qualified provider (rate does not vary by provider) · Michigan Medicaid (fee-for-service) | $2.70since 2024-07-01 | — | — | Plans negotiate; applies out of network | — | MDHHS Practitioner and Medical Clinic Fe |
| North CarolinaAny qualified provider (rate does not vary by provider) · North Carolina Medicaid Direct (fee-for-service) | $1.22since 2022-01-01 | — | — | Plans must pay at least this | — | NC Medicaid fee schedule 'Nurse Midwives |
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 J1170?
It depends on the state. Of the 6 states with a published fee-for-service rate, the median is $2.70. New Mexico pays the most ($6.89) and North Carolina the least ($1.22).
Which state pays the highest Medicaid rate for J1170?
New Mexico, at $6.89, effective 2025-01-01.
Do managed-care plans pay the same rate for J1170?
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.