J1428 Medicaid reimbursement rates by state
Injection, eteplirsen, 10 mg. 24 state Medicaid programs publish a fee-for-service rate for J1428 at the physician psychologist level. Rates run from $64.80 in Minnesota to $172.60 in Ohio, with a median of $160.80.
Data as of 2026-10-05. Every rate links to the official document it came from.
- States publishing
- 24
- Median rate
- $160.80units vary by state
- Highest
- $172.60Ohio
- Medicare (non-facility)
- —not on the physician fee schedule
J1428 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 |
|---|---|---|---|---|---|---|
| OhioAny qualified provider (rate does not vary by provider) · Ohio Medicaid (fee-for-service) | $172.60since 2018-11-01 | — | — | Plans negotiate; applies out of network | — | ODM provider-administered pharmaceutical |
| NebraskaAny qualified provider (rate does not vary by provider) · Nebraska Medicaid (fee-for-service) | $170.88since 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) | $169.60since 2025-04-01 | — | — | Plans negotiate; applies out of network | — | MDHHS Practitioner and Medical Clinic Fe |
| New MexicoAny qualified provider (rate does not vary by provider) · New Mexico Medicaid (fee-for-service, HCA Medical Assistance Division) | $169.60since 2025-01-01 | — | — | Plans must pay at least this | — | New Mexico Medicaid Fee for Service HCPC |
| IndianaAny qualified provider (rate does not vary by provider) · Indiana Medicaid (fee-for-service) | $168.00since 2018-01-01 | unit | — | Paid by the state, outside plans | — | IHCP Professional Fee Schedule (Last Upd |
| MississippiAny qualified provider (rate does not vary by provider) · Mississippi Medicaid (fee-for-service) | $167.51since 2026-07-01 | — | — | Plans must pay at least this | — | DOM Comprehensive Fee Schedule, Septembe |
| CaliforniaAny qualified provider (rate does not vary by provider) · California Medi-Cal (fee-for-service) | $164.46since 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) | $163.20since 2018-04-01 | — | — | Plans negotiate; applies out of network | — | TMHP Texas Medicaid Fee Schedule - Physi |
| South DakotaAny qualified provider (rate does not vary by provider) · South Dakota Medicaid (fee-for-service, DSS Division of Medical Services) | $162.24since 2026-07-01 | — | — | Not classified | — | South Dakota Medicaid Drugs and Biologic |
| IowaPhysician or licensed psychologist (incl. BCBA-D) · Iowa Medicaid (fee-for-service schedules; the floor IA Health Link plans must pay) | $162.05since 2022-05-01 | — | — | Plans must pay at least this | — | Iowa Medicaid fee schedule #02 PHYSICIAN |
| South CarolinaAny qualified provider (rate does not vary by provider) · South Carolina Healthy Connections Medicaid (fee-for-service) | $161.60since 2023-01-01 | — | — | Not classified | — | SCDHHS Infusion Center Fee Schedule (sch |
| NevadaPhysician or licensed psychologist (incl. BCBA-D) · Nevada Medicaid (fee-for-service provider-type reimbursement schedules) | $161.60since 2024-04-01 | — | — | Plans must pay at least this | — | Physician Administered Drug (PAD) Pricin |
| Rhode IslandAny qualified provider (rate does not vary by provider) · Rhode Island Medicaid (fee-for-service) | $160.00since 2018-01-01 | — | — | Plans negotiate; applies out of network | — | RI Medicaid Interactive Fee For Service |
| UtahAny qualified provider (rate does not vary by provider) · Utah Medicaid (fee-for-service, Traditional plan) | $160.00since 2019-10-01 | — | — | Plans negotiate; applies out of network | — | Utah Medicaid Coverage and Reimbursement |
| KansasAny qualified provider (rate does not vary by provider) · Kansas Medicaid QMB (Qualified Medicare Beneficiary) KMAP fee schedule | $160.00since 2021-04-01 | — | — | Not classified | — | KMAP Fee Schedule QMB Medicaid (FeeSched |
| ArizonaAny qualified provider (rate does not vary by provider) · Arizona AHCCCS fee-for-service (AIHP, Tribal ALTCS, TRBHA and other FFS members) | $160.00since 2026-08-01 | — | — | Plans negotiate; applies out of network | — | AHCCCS FFS Capped Fee Schedule: Physicia |
| GeorgiaAny qualified provider (rate does not vary by provider) · Georgia Medicaid (fee-for-service) | $160.00since 2018-04-01 | — | — | Plans negotiate; applies out of network | — | PADL_Appendix A_Schedule of Maximum Allo |
| ColoradoAny qualified provider (rate does not vary by provider) · Health First Colorado (Colorado Medicaid, fee-for-service) | $160.00since 2022-01-01 | — | — | Not classified | — | Q1/Q2/Q3/Q4 2022 PAD Fee Schedule |
| OklahomaAny qualified provider (rate does not vary by provider) · Oklahoma SoonerCare (fee-for-service, OHCA) | $160.00since 2024-01-01 | — | — | State sets the plan rate | — | SoonerCare Title XIX Fee Schedule |
| New HampshireAny qualified provider (rate does not vary by provider) · New Hampshire Medicaid (fee-for-service, DHHS / NH MMIS) | $160.00since 2021-05-01 | — | — | 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) | $158.40since 2025-01-01 | — | — | Not classified | — | NJMMIS Procedure Master Listing CPTHCPCS |
| IllinoisAny qualified provider (rate does not vary by provider) · Illinois Medicaid (HFS fee-for-service) | $148.83since 2026-04-01 | — | — | Plans negotiate; applies out of network | — | HFS Practitioner Fee Schedule (effective |
| ArkansasPhysician or licensed psychologist (incl. BCBA-D) · Arkansas Medicaid (fee-for-service) | $128.00since 2025-06-13 | — | — | Not classified | — | Arkansas Medicaid Physician / CRNA / Fam |
| MinnesotaAny qualified provider (rate does not vary by provider) · Minnesota Health Care Programs: Medical Assistance (fee-for-service) | $64.80since 2025-06-01 | — | — | Plans negotiate; applies out of network | — | MHCP Fee Schedule - Current Fee Schedule |
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 J1428?
It depends on the state. Of the 24 states with a published fee-for-service rate, the median is $160.80. Ohio pays the most ($172.60) and Minnesota the least ($64.80).
Which state pays the highest Medicaid rate for J1428?
Ohio, at $172.60, effective 2018-11-01.
Do managed-care plans pay the same rate for J1428?
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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