J1438 Medicaid reimbursement rates by state
Injection, etanercept, 25 mg. 24 state Medicaid programs publish a fee-for-service rate for J1438 at the physician psychologist level. Rates run from $180.50 in New Jersey to $1,143.50 in Nebraska, with a median of $824.87.
Data as of 2026-10-05. Every rate links to the official document it came from.
- States publishing
- 24
- Median rate
- $824.87units vary by state
- Highest
- $1,143.50Nebraska
- Medicare (non-facility)
- —not on the physician fee schedule
J1438 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 |
|---|---|---|---|---|---|---|
| NebraskaAny qualified provider (rate does not vary by provider) · Nebraska Medicaid (fee-for-service) | $1,143.50since 2026-07-01 | — | — | Plans negotiate; applies out of network | — | Nebraska Medicaid fee schedule 471-000-5 |
| IndianaAny qualified provider (rate does not vary by provider) · Indiana Medicaid (fee-for-service) | $1,124.22since 2026-04-01 | unit | — | Plans must pay at least this | — | IHCP Professional Fee Schedule (Last Upd |
| TexasPhysician or licensed psychologist (incl. BCBA-D) · Texas Medicaid (fee-for-service, TMHP) | $1,092.11since 2026-09-01 | — | — | Plans negotiate; applies out of network | — | TMHP Texas Medicaid Fee Schedule - Physi |
| MaineAny qualified provider (rate does not vary by provider) · MaineCare (fee-for-service) | $1,080.88since 2025-07-01 | — | — | Not classified | — | MaineCare Section 90 - Drug Rates/Fee Sc |
| ArizonaAny qualified provider (rate does not vary by provider) · Arizona AHCCCS fee-for-service (AIHP, Tribal ALTCS, TRBHA and other FFS members) | $1,070.69since 2026-08-01 | — | — | Plans negotiate; applies out of network | — | AHCCCS FFS Capped Fee Schedule: Physicia |
| ColoradoAny qualified provider (rate does not vary by provider) · Health First Colorado (Colorado Medicaid, fee-for-service) | $1,070.69since 2026-04-01 | — | — | Not classified | — | Q1/Q2/Q3/Q4 2026 PAD Fee Schedule |
| KansasAny qualified provider (rate does not vary by provider) · Kansas Medicaid QMB (Qualified Medicare Beneficiary) KMAP fee schedule | $1,070.69since 2026-04-01 | — | — | Not classified | — | KMAP Fee Schedule QMB Medicaid (FeeSched |
| MississippiAny qualified provider (rate does not vary by provider) · Mississippi Medicaid (fee-for-service) | $1,070.69since 2026-07-01 | — | — | Plans must pay at least this | — | DOM Comprehensive Fee Schedule, Septembe |
| NevadaPhysician or licensed psychologist (incl. BCBA-D) · Nevada Medicaid (fee-for-service provider-type reimbursement schedules) | $1,053.55since 2026-06-01 | — | — | Plans must pay at least this | — | Physician Administered Drug (PAD) Pricin |
| WashingtonAny qualified provider (rate does not vary by provider) · Washington Apple Health (Medicaid) fee-for-service | $1,038.12since 2026-07-01 | — | — | Plans negotiate; applies out of network | — | HCA Professional administered drugs fee |
| IowaPhysician or licensed psychologist (incl. BCBA-D) · Iowa Medicaid (fee-for-service schedules; the floor IA Health Link plans must pay) | $892.45since 2024-03-01 | — | — | Plans must pay at least this | — | Iowa Medicaid fee schedule #02 PHYSICIAN |
| MinnesotaAny qualified provider (rate does not vary by provider) · Minnesota Health Care Programs: Medical Assistance (fee-for-service) | $842.40since 2026-06-01 | — | — | Plans negotiate; applies out of network | — | MHCP Fee Schedule - Current Fee Schedule |
| South CarolinaAny qualified provider (rate does not vary by provider) · South Carolina Healthy Connections Medicaid (fee-for-service) | $807.33since 2023-01-01 | — | — | Not classified | — | SCDHHS Infusion Center Fee Schedule (sch |
| AlabamaAny qualified provider (rate does not vary by provider) · Alabama Medicaid (fee-for-service, Alabama Medicaid Agency fee schedules) | $801.23since 2026-08-25 | — | — | Not classified | — | Physician Drug Fee Schedule (REF-0130-Q) |
| New MexicoAny qualified provider (rate does not vary by provider) · New Mexico Medicaid (fee-for-service, HCA Medical Assistance Division) | $436.41since 2025-01-01 | — | — | Plans must pay at least this | — | New Mexico Medicaid Fee for Service HCPC |
| OhioAny qualified provider (rate does not vary by provider) · Ohio Medicaid (fee-for-service) | $411.71since 2016-07-01 | — | — | Plans negotiate; applies out of network | — | ODM provider-administered pharmaceutical |
| MichiganAny qualified provider (rate does not vary by provider) · Michigan Medicaid (fee-for-service) | $411.71since 2023-01-01 | — | — | Plans negotiate; applies out of network | — | MDHHS Child and Adolescent Health Center |
| VirginiaAny qualified provider (rate does not vary by provider) · Virginia Medicaid (fee-for-service, DMAS) | $411.71since 2016-07-01 | — | — | Plans negotiate; applies out of network | — | DMAS procedure fee file hcpcmedical.csv |
| WisconsinAny qualified provider (rate does not vary by provider) · Wisconsin Medicaid and BadgerCare Plus (fee-for-service, ForwardHealth maximum allowable fees) | $411.71since 2016-07-01 | — | — | Plans negotiate; applies out of network | — | ForwardHealth max fee schedule: Medical- |
| OklahomaAny qualified provider (rate does not vary by provider) · Oklahoma SoonerCare (fee-for-service, OHCA) | $411.71since 2024-01-01 | — | — | State sets the plan rate | — | SoonerCare Title XIX Fee Schedule |
| MarylandAny qualified provider (rate does not vary by provider) · Maryland Medicaid (fee-for-service, MDH) | $330.81since 2026-01-01 | — | — | Not classified | — | Maryland Medicaid Professional Services |
| IdahoAny qualified provider (rate does not vary by provider) · Idaho Medicaid (fee-for-service, Division of Medicaid / Gainwell) | $304.22since 2025-09-01 | — | — | Not classified | — | Idaho Medicaid Numerical Fee Schedule Ju |
| IllinoisAny qualified provider (rate does not vary by provider) · Illinois Medicaid (HFS fee-for-service) | $186.86since 2010-02-01 | — | — | Plans negotiate; applies out of network | — | HFS Practitioner Fee Schedule (effective |
| New JerseyAny qualified provider (rate does not vary by provider) · New Jersey Medicaid / NJ FamilyCare (fee-for-service) | $180.50since 2025-01-01 | — | — | Not classified | — | NJMMIS Procedure Master Listing CPTHCPCS |
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 J1438?
It depends on the state. Of the 24 states with a published fee-for-service rate, the median is $824.87. Nebraska pays the most ($1,143.50) and New Jersey the least ($180.50).
Which state pays the highest Medicaid rate for J1438?
Nebraska, at $1,143.50, effective 2026-07-01.
Do managed-care plans pay the same rate for J1438?
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 J1438 in your statesYour codes on one rate card: every payer's rule, Medicare comparison, rank and rate changes.