J1246 Medicaid reimbursement rates by state
Physician-administered drugs (J-codes). 5 state Medicaid programs publish a fee-for-service rate for J1246. Rates run from $90.12 in California to $119.62 in Alabama, with a median of $96.11.
Data as of 2026-10-05. Every rate links to the official document it came from.
- States publishing
- 5
- Median rate
- $96.11units vary by state
- Highest
- $119.62Alabama
- Medicare (non-facility)
- —not on the physician fee schedule
J1246 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 |
|---|---|---|---|---|---|---|
| AlabamaAny qualified provider (rate does not vary by provider) · Alabama Medicaid (fee-for-service, Alabama Medicaid Agency fee schedules) | $119.62since 2026-08-25 | — | — | Not classified | — | Physician Drug Fee Schedule (REF-0130-Q) |
| LouisianaAny qualified provider (rate does not vary by provider) · Louisiana Medicaid (fee-for-service) | $108.84since 2025-01-01 | — | — | Plans must pay at least this | — | Louisiana Medicaid Professional Services |
| South DakotaAny qualified provider (rate does not vary by provider) · South Dakota Medicaid (fee-for-service, DSS Division of Medical Services) | $96.11since 2026-07-01 | — | — | Not classified | — | South Dakota Medicaid Drugs and Biologic |
| Rhode IslandAny qualified provider (rate does not vary by provider) · Rhode Island Medicaid (fee-for-service) | $93.61since 2024-01-01 | — | — | Plans negotiate; applies out of network | — | RI Medicaid Interactive Fee For Service |
| CaliforniaAny qualified provider (rate does not vary by provider) · California Medi-Cal (fee-for-service) | $90.12since 2024-01-01 | — | — | Plans negotiate; applies out of network | — | Medi Cal Physician Administered Drug Rat |
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 J1246?
It depends on the state. Of the 5 states with a published fee-for-service rate, the median is $96.11. Alabama pays the most ($119.62) and California the least ($90.12).
Which state pays the highest Medicaid rate for J1246?
Alabama, at $119.62, effective 2026-08-25.
Do managed-care plans pay the same rate for J1246?
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.