J1726 Medicaid reimbursement rates by state
Injection, hydroxyprogesterone caproate, (makena), 10 mg. 12 state Medicaid programs publish a fee-for-service rate for J1726 at the physician psychologist level. Rates run from $13.82 in Maine to $37.47 in New Mexico, with a median of $29.23.
Data as of 2026-10-05. Every rate links to the official document it came from.
- States publishing
- 12
- Median rate
- $29.23units vary by state
- Highest
- $37.47New Mexico
- Medicare (non-facility)
- —not on the physician fee schedule
J1726 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) | $37.47since 2025-01-01 | — | — | Plans must pay at least this | — | New Mexico Medicaid Fee for Service HCPC |
| MontanaAny qualified provider (rate does not vary by provider) · Montana Medicaid and HMK Plus (fee-for-service) | $36.80since 2025-07-01 | — | — | Not classified | — | Montana Healthcare Programs fee schedule |
| ArkansasPhysician or licensed psychologist (incl. BCBA-D) · Arkansas Medicaid (fee-for-service) | $36.61since 2025-06-13 | — | — | Not classified | — | Arkansas Medicaid Physician / CRNA / Fam |
| North CarolinaAny qualified provider (rate does not vary by provider) · North Carolina Medicaid Direct (fee-for-service) | $33.02since 2022-01-01 | — | — | Plans negotiate; applies out of network | — | NC Medicaid fee schedule 'Ambulatory Inf |
| MichiganAny qualified provider (rate does not vary by provider) · Michigan Medicaid (fee-for-service) | $32.40since 2023-01-01 | — | — | Plans negotiate; applies out of network | — | MDHHS Child and Adolescent Health Center |
| OhioAny qualified provider (rate does not vary by provider) · Ohio Medicaid (fee-for-service) | $31.16since 2018-01-01 | — | — | Plans negotiate; applies out of network | — | ODM provider-administered pharmaceutical |
| KansasAny qualified provider (rate does not vary by provider) · Kansas Medicaid QMB (Qualified Medicare Beneficiary) KMAP fee schedule | $27.30since 2021-04-01 | — | — | Not classified | — | KMAP Fee Schedule QMB Medicaid (FeeSched |
| South CarolinaAny qualified provider (rate does not vary by provider) · South Carolina Healthy Connections Medicaid (fee-for-service) | $19.89since 2023-07-01 | — | — | Not classified | — | SCDHHS Infusion Center Fee Schedule (sch |
| ArizonaAny qualified provider (rate does not vary by provider) · Arizona AHCCCS fee-for-service (AIHP, Tribal ALTCS, TRBHA and other FFS members) | $19.65since 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) | $19.65since 2023-04-01 | — | — | Plans negotiate; applies out of network | — | Copy of PADL- Appendix A Published Copy_ |
| CaliforniaAny qualified provider (rate does not vary by provider) · California Medi-Cal (fee-for-service) | $14.09since 2024-01-01 | — | — | Plans negotiate; applies out of network | — | Medi Cal Physician Administered Drug Rat |
| MaineAny qualified provider (rate does not vary by provider) · MaineCare (fee-for-service) | $13.82since 2025-01-01 | — | — | Not classified | — | MaineCare Fee Schedule (MaineCare UCR, H |
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 J1726?
It depends on the state. Of the 12 states with a published fee-for-service rate, the median is $29.23. New Mexico pays the most ($37.47) and Maine the least ($13.82).
Which state pays the highest Medicaid rate for J1726?
New Mexico, at $37.47, effective 2025-01-01.
Do managed-care plans pay the same rate for J1726?
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.