J1961 Medicaid reimbursement rates by state
Injection, lenacapavir (only for use as hiv treatment), 1 mg. 24 state Medicaid programs publish a fee-for-service rate for J1961 at the physician psychologist level. Rates run from $20.83 in New Jersey to $26.76 in California, with a median of $22.94.
Data as of 2026-10-05. Every rate links to the official document it came from.
- States publishing
- 24
- Median rate
- $22.94units vary by state
- Highest
- $26.76California
- Medicare (non-facility)
- —not on the physician fee schedule
J1961 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 |
|---|---|---|---|---|---|---|
| CaliforniaAny qualified provider (rate does not vary by provider) · California Medi-Cal (fee-for-service) | $26.76since 2026-10-01 | — | — | Plans negotiate; applies out of network | — | Medi-Cal Rates (Rates files zip: rates_d |
| ArkansasAny qualified provider (rate does not vary by provider) · Arkansas Medicaid (fee-for-service) | $23.98since 2025-06-13 | — | — | Not classified | — | Arkansas Medicaid Nurse Practitioner Fee |
| ArizonaAny qualified provider (rate does not vary by provider) · Arizona AHCCCS fee-for-service (AIHP, Tribal ALTCS, TRBHA and other FFS members) | $22.94since 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) | $22.94since 2026-07-01 | — | — | Plans negotiate; applies out of network | — | PADL Fee Schedule -Published Copy - July |
| North CarolinaAny qualified provider (rate does not vary by provider) · North Carolina Medicaid Direct (fee-for-service) | $22.94since 2026-08-01 | — | — | Plans negotiate; applies out of network | — | NC Medicaid fee schedule 'Physician Admi |
| OhioAny qualified provider (rate does not vary by provider) · Ohio Medicaid (fee-for-service) | $22.94since 2026-07-01 | — | — | Plans negotiate; applies out of network | — | ODM provider-administered pharmaceutical |
| WashingtonAny qualified provider (rate does not vary by provider) · Washington Apple Health (Medicaid) fee-for-service | $22.94since 2026-07-01 | — | — | Plans negotiate; applies out of network | — | HCA Professional administered drugs fee |
| MichiganAny qualified provider (rate does not vary by provider) · Michigan Medicaid (fee-for-service) | $22.94since 2026-07-01 | — | — | Plans negotiate; applies out of network | — | MDHHS Certified Nurse Midwife Fee Schedu |
| WisconsinAny qualified provider (rate does not vary by provider) · Wisconsin Medicaid and BadgerCare Plus (fee-for-service, ForwardHealth maximum allowable fees) | $22.94since 2026-07-01 | — | — | Plans negotiate; applies out of network | — | ForwardHealth max fee schedule: Medical- |
| South CarolinaAny qualified provider (rate does not vary by provider) · South Carolina Healthy Connections Medicaid (fee-for-service) | $22.94since 2026-07-01 | — | — | Not classified | — | SCDHHS Infusion Center Fee Schedule (sch |
| OregonAny qualified provider (rate does not vary by provider) · Oregon Health Plan (fee-for-service, OHA) | $22.94since 2026-07-01 | — | — | Plans negotiate; applies out of network | — | OHP FFS medical-dental fee schedule (fee |
| OklahomaAny qualified provider (rate does not vary by provider) · Oklahoma SoonerCare (fee-for-service, OHCA) | $22.94since 2026-07-01 | — | — | State sets the plan rate | — | SoonerCare Title XIX Fee Schedule |
| KansasAny qualified provider (rate does not vary by provider) · Kansas Medicaid (KMAP fee-for-service schedule) | $22.94since 2026-07-01 | — | — | Plans must pay at least this | — | KMAP Fee Schedule TXIX Medicaid (FeeSche |
| NebraskaAny qualified provider (rate does not vary by provider) · Nebraska Medicaid (fee-for-service) | $22.93since 2026-07-01 | — | — | Plans negotiate; applies out of network | — | Nebraska Medicaid fee schedule 471-000-5 |
| MinnesotaAny qualified provider (rate does not vary by provider) · Minnesota Health Care Programs: Medical Assistance (fee-for-service) | $22.93since 2026-07-01 | — | — | Plans negotiate; applies out of network | — | MHCP Fee Schedule - Current Fee Schedule |
| ConnecticutAny qualified provider (rate does not vary by provider) · Connecticut Medicaid / HUSKY Health (fee-for-service, CMAP) | $22.30since 2026-01-01 | — | — | Not classified | — | CMAP fee schedule: Physician Office and |
| TexasPhysician or licensed psychologist (incl. BCBA-D) · Texas Medicaid (fee-for-service, TMHP) | $22.30since 2026-09-01 | — | — | Plans negotiate; applies out of network | — | TMHP Texas Medicaid Fee Schedule - Physi |
| MarylandAny qualified provider (rate does not vary by provider) · Maryland Medicaid (fee-for-service, MDH) | $22.30since 2026-01-01 | — | — | Not classified | — | Maryland Medicaid Professional Services |
| AlabamaAny qualified provider (rate does not vary by provider) · Alabama Medicaid (fee-for-service, Alabama Medicaid Agency fee schedules) | $22.30since 2026-08-25 | — | — | Not classified | — | Physician Drug Fee Schedule (REF-0130-Q) |
| ColoradoAny qualified provider (rate does not vary by provider) · Health First Colorado (Colorado Medicaid, fee-for-service) | $22.18since 2026-07-01 | — | — | Not classified | — | Q1/Q2/Q3/Q4 2026 PAD Fee Schedule |
| IndianaAny qualified provider (rate does not vary by provider) · Indiana Medicaid (fee-for-service) | $22.09since 2026-01-01 | unit | — | Plans must pay at least this | — | IHCP Professional Fee Schedule (Last Upd |
| IllinoisAny qualified provider (rate does not vary by provider) · Illinois Medicaid (HFS fee-for-service) | $21.70since 2026-04-01 | — | — | Plans negotiate; applies out of network | — | HFS Practitioner Fee Schedule (effective |
| IowaPhysician or licensed psychologist (incl. BCBA-D) · Iowa Medicaid (fee-for-service schedules; the floor IA Health Link plans must pay) | $21.30since 2024-03-01 | — | — | Plans must pay at least this | — | Iowa Medicaid fee schedule #02 PHYSICIAN |
| New JerseyAny qualified provider (rate does not vary by provider) · New Jersey Medicaid / NJ FamilyCare (fee-for-service) | $20.83since 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 J1961?
It depends on the state. Of the 24 states with a published fee-for-service rate, the median is $22.94. California pays the most ($26.76) and New Jersey the least ($20.83).
Which state pays the highest Medicaid rate for J1961?
California, at $26.76, effective 2026-10-01.
Do managed-care plans pay the same rate for J1961?
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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