J3394 Medicaid reimbursement rates by state
Injection, lovotibeglogene autotemcel, per treatment. 7 state Medicaid programs publish a fee-for-service rate for J3394 at the physician psychologist level. Rates run from $0.00 in California to $3,162,000.00 in Texas, with a median of $3,100,000.00.
Data as of 2026-10-05. Every rate links to the official document it came from.
- States publishing
- 7
- Median rate
- $3,100,000.00units vary by state
- Highest
- $3,162,000.00Texas
- Medicare (non-facility)
- —not on the physician fee schedule
J3394 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) | $3,162,000.00since 2025-01-01 | — | — | 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) | $3,100,000.00since 2024-10-01 | — | — | Plans negotiate; applies out of network | — | Provider's Administered Drug List - Exce |
| OklahomaAny qualified provider (rate does not vary by provider) · Oklahoma SoonerCare (fee-for-service, OHCA) | $3,100,000.00since 2024-07-01 | — | — | State sets the plan rate | — | SoonerCare Title XIX Fee Schedule |
| KansasAny qualified provider (rate does not vary by provider) · Kansas Medicaid QMB (Qualified Medicare Beneficiary) KMAP fee schedule | $3,100,000.00since 2026-10-01 | — | — | Not classified | — | KMAP Fee Schedule QMB Medicaid (FeeSched |
| IllinoisAny qualified provider (rate does not vary by provider) · Illinois Medicaid (HFS fee-for-service) | $2,883,582.80since 2026-04-01 | — | — | Plans negotiate; applies out of network | — | HFS Practitioner Fee Schedule (effective |
| ArizonaAny qualified provider (rate does not vary by provider) · Arizona AHCCCS fee-for-service (AIHP, Tribal ALTCS, TRBHA and other FFS members) | $2,790,000.00since 2026-08-01 | — | — | Plans negotiate; applies out of network | — | AHCCCS FFS Capped Fee Schedule: Physicia |
| CaliforniaAny qualified provider (rate does not vary by provider) · California Medi-Cal (fee-for-service) | $0.00since 2024-07-01 | — | — | Plans negotiate; applies out of network | — | Medi Cal Physician Administered Drug Rat |
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 J3394?
It depends on the state. Of the 7 states with a published fee-for-service rate, the median is $3,100,000.00. Texas pays the most ($3,162,000.00) and California the least ($0.00).
Which state pays the highest Medicaid rate for J3394?
Texas, at $3,162,000.00, effective 2025-01-01.
Do managed-care plans pay the same rate for J3394?
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.