J2355 Medicaid reimbursement rates by state
Injection, oprelvekin, 5 mg. 19 state Medicaid programs publish a fee-for-service rate for J2355 at the physician psychologist level. Rates run from $1.34 in Maine to $528.92 in Texas, with a median of $426.92.
Data as of 2026-10-05. Every rate links to the official document it came from.
- States publishing
- 19
- Median rate
- $426.92units vary by state
- Highest
- $528.92Texas
- Medicare (non-facility)
- —not on the physician fee schedule
J2355 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 |
|---|---|---|---|---|---|---|
| TexasPhysician or licensed psychologist (incl. BCBA-D) · Texas Medicaid (fee-for-service, TMHP) | $528.92since 2019-04-01 | — | — | Plans negotiate; applies out of network | — | TMHP Texas Medicaid Fee Schedule - Physi |
| GeorgiaAny qualified provider (rate does not vary by provider) · Georgia Medicaid (fee-for-service) | $467.22since 2017-07-01 | — | — | Plans negotiate; applies out of network | — | Schedule of Maximum Allowable-PADL-Appen |
| New MexicoAny qualified provider (rate does not vary by provider) · New Mexico Medicaid (fee-for-service, HCA Medical Assistance Division) | $452.53since 2025-01-01 | — | — | Plans must pay at least this | — | New Mexico Medicaid Fee for Service HCPC |
| ArizonaAny qualified provider (rate does not vary by provider) · Arizona AHCCCS fee-for-service (AIHP, Tribal ALTCS, TRBHA and other FFS members) | $427.10since 2024-04-01 | — | — | Plans negotiate; applies out of network | — | AHCCCS FFS Capped Fee Schedule: Physicia |
| OhioAny qualified provider (rate does not vary by provider) · Ohio Medicaid (fee-for-service) | $426.92since 2018-08-01 | — | — | 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 | $426.92since 2021-01-01 | — | — | 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) | $426.92since 2023-01-01 | — | — | Plans negotiate; applies out of network | — | MDHHS Practitioner and Medical Clinic Fe |
| WisconsinAny qualified provider (rate does not vary by provider) · Wisconsin Medicaid and BadgerCare Plus (fee-for-service, ForwardHealth maximum allowable fees) | $426.92since 2018-07-01 | — | — | Plans negotiate; applies out of network | — | ForwardHealth max fee schedule: Medical- |
| OregonAny qualified provider (rate does not vary by provider) · Oregon Health Plan (fee-for-service, OHA) | $426.92since 2018-07-01 | — | — | Plans negotiate; applies out of network | — | OHP FFS medical-dental fee schedule (fee |
| KansasAny qualified provider (rate does not vary by provider) · Kansas Medicaid QMB (Qualified Medicare Beneficiary) KMAP fee schedule | $426.92since 2018-07-01 | — | — | Not classified | — | KMAP Fee Schedule QMB Medicaid (FeeSched |
| VirginiaAny qualified provider (rate does not vary by provider) · Virginia Medicaid (fee-for-service, DMAS) | $426.91since 2018-07-01 | — | — | Plans negotiate; applies out of network | — | DMAS procedure fee file hcpcmedical.csv |
| IdahoAny qualified provider (rate does not vary by provider) · Idaho Medicaid (fee-for-service, Division of Medicaid / Gainwell) | $403.67since 2025-09-01 | — | — | Not classified | — | Idaho Medicaid Numerical Fee Schedule Ju |
| South CarolinaAny qualified provider (rate does not vary by provider) · South Carolina Healthy Connections Medicaid (fee-for-service) | $287.11since 2015-07-01 | — | — | Not classified | — | SCDHHS Infusion Center Fee Schedule (sch |
| New JerseyAny qualified provider (rate does not vary by provider) · New Jersey Medicaid / NJ FamilyCare (fee-for-service) | $267.75since 2025-01-01 | — | — | Not classified | — | NJMMIS Procedure Master Listing CPTHCPCS |
| MinnesotaAny qualified provider (rate does not vary by provider) · Minnesota Health Care Programs: Medical Assistance (fee-for-service) | $264.46since 2025-01-01 | — | — | Plans negotiate; applies out of network | — | MHCP Fee Schedule (Wayback capture 20250 |
| IowaPhysician or licensed psychologist (incl. BCBA-D) · Iowa Medicaid (fee-for-service schedules; the floor IA Health Link plans must pay) | $255.67since 2013-07-01 | — | — | Plans must pay at least this | — | Iowa Medicaid fee schedule #02 PHYSICIAN |
| ArkansasPhysician or licensed psychologist (incl. BCBA-D) · Arkansas Medicaid (fee-for-service) | $239.67since 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) | $235.73since 2015-01-01 | — | — | Plans must pay at least this | — | NC Medicaid fee schedule 'Nurse Practiti |
| MaineAny qualified provider (rate does not vary by provider) · MaineCare (fee-for-service) | $1.34since 2020-01-01 | — | — | 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 J2355?
It depends on the state. Of the 19 states with a published fee-for-service rate, the median is $426.92. Texas pays the most ($528.92) and Maine the least ($1.34).
Which state pays the highest Medicaid rate for J2355?
Texas, at $528.92, effective 2019-04-01.
Do managed-care plans pay the same rate for J2355?
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 J2355 in your statesYour codes on one rate card: every payer's rule, Medicare comparison, rank and rate changes.