J3405 Medicaid reimbursement rates by state
Injection, onasemnogene abeparvovec-brve, per treatment. 12 state Medicaid programs publish a fee-for-service rate for J3405 at the physician psychologist level. Rates run from $0.00 in Arkansas to $2,729,937.92 in West Virginia, with a median of $2,627,114.30.
Data as of 2026-10-05. Every rate links to the official document it came from.
- States publishing
- 12
- Median rate
- $2,627,114.30units vary by state
- Highest
- $2,729,937.92West Virginia
- Medicare (non-facility)
- —not on the physician fee schedule
J3405 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 |
|---|---|---|---|---|---|---|
| West VirginiaAny qualified provider (rate does not vary by provider) · West Virginia Medicaid (fee-for-service, Bureau for Medical Services) | $2,729,937.92since 2026-10-01 | Per treatment | — | Plans negotiate; applies out of network | — | BMS Physician Administered Drug ASP Pric |
| OhioAny qualified provider (rate does not vary by provider) · Ohio Medicaid (fee-for-service) | $2,729,937.92since 2026-10-01 | — | — | Plans negotiate; applies out of network | — | ODM provider-administered pharmaceutical |
| KansasAny qualified provider (rate does not vary by provider) · Kansas Medicaid (KMAP fee-for-service schedule) | $2,729,937.92since 2026-10-01 | — | — | Plans must pay at least this | — | KMAP Fee Schedule TXIX Medicaid (FeeSche |
| IndianaAny qualified provider (rate does not vary by provider) · Indiana Medicaid (fee-for-service) | $2,715,961.19since 2026-07-01 | unit | — | Paid by the state, outside plans | — | IHCP Professional Fee Schedule (Last Upd |
| NevadaPhysician or licensed psychologist (incl. BCBA-D) · Nevada Medicaid (fee-for-service provider-type reimbursement schedules) | $2,664,718.87since 2026-09-01 | — | — | Plans must pay at least this | — | Physician Administered Drug (PAD) Pricin |
| MississippiAny qualified provider (rate does not vary by provider) · Mississippi Medicaid (fee-for-service) | $2,664,228.59since 2026-07-01 | — | — | Plans must pay at least this | — | DOM Comprehensive Fee Schedule, Septembe |
| District of ColumbiaAny qualified provider (rate does not vary by provider) · DC Medicaid (DHCF) fee-for-service | $2,590,000.00since 2026-04-01 | — | — | Not classified | — | REFRP00178CSV - Medical Fee Schedule Rep |
| MinnesotaAny qualified provider (rate does not vary by provider) · Minnesota Health Care Programs: Medical Assistance (fee-for-service) | $2,586,629.70since 2026-07-01 | — | — | Plans negotiate; applies out of network | — | MHCP Fee Schedule - Current Fee Schedule |
| IllinoisAny qualified provider (rate does not vary by provider) · Illinois Medicaid (HFS fee-for-service) | $2,478,233.46since 2026-07-01 | — | — | 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) | $2,397,805.73since 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 2026-07-01 | — | — | Plans negotiate; applies out of network | — | Medi-Cal Physician-Administered Drug Rat |
| ArkansasPhysician or licensed psychologist (incl. BCBA-D) · Arkansas Medicaid (fee-for-service) | $0.00since 2026-08-10 | — | — | Not classified | — | Arkansas Medicaid Physician / CRNA / Fam |
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 J3405?
It depends on the state. Of the 12 states with a published fee-for-service rate, the median is $2,627,114.30. West Virginia pays the most ($2,729,937.92 per Per treatment) and Arkansas the least ($0.00).
Which state pays the highest Medicaid rate for J3405?
West Virginia, at $2,729,937.92 per Per treatment, effective 2026-10-01.
Do managed-care plans pay the same rate for J3405?
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.