J7191 Medicaid reimbursement rates by state
Factor viii (antihemophilic factor (porcine)), per i.u.. 11 state Medicaid programs publish a fee-for-service rate for J7191. Rates run from $1.68 in New Mexico to $5.46 in Maine, with a median of $1.87.
Data as of 2026-10-05. Every rate links to the official document it came from.
- States publishing
- 11
- Median rate
- $1.87units vary by state
- Highest
- $5.46Maine
- Medicare (non-facility)
- —not on the physician fee schedule
J7191 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 |
|---|---|---|---|---|---|---|
| MaineAny qualified provider (rate does not vary by provider) · MaineCare (fee-for-service) | $5.46since 2026-01-01 | — | — | Not classified | — | MaineCare Fee Schedule (MaineCare UCR, H |
| IllinoisAny qualified provider (rate does not vary by provider) · Illinois Medicaid (HFS fee-for-service) | $2.18since 2010-02-01 | — | — | 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) | $1.94since 2024-04-01 | — | — | Plans negotiate; applies out of network | — | AHCCCS FFS Capped Fee Schedule: Physicia |
| New JerseyAny qualified provider (rate does not vary by provider) · New Jersey Medicaid / NJ FamilyCare (fee-for-service) | $1.93since 2025-01-01 | — | — | Not classified | — | NJMMIS Procedure Master Listing CPTHCPCS |
| KansasAny qualified provider (rate does not vary by provider) · Kansas Medicaid QMB (Qualified Medicare Beneficiary) KMAP fee schedule | $1.93since 2005-04-22 | — | — | Not classified | — | KMAP Fee Schedule QMB Medicaid (FeeSched |
| OregonAny qualified provider (rate does not vary by provider) · Oregon Health Plan (fee-for-service, OHA) | $1.87since 2010-08-01 | — | — | Plans negotiate; applies out of network | — | OHP FFS medical-dental fee schedule (fee |
| VirginiaAny qualified provider (rate does not vary by provider) · Virginia Medicaid (fee-for-service, DMAS) | $1.86since 2005-04-01 | — | — | Plans negotiate; applies out of network | — | DMAS procedure fee file hcpcmedical.csv |
| WisconsinAny qualified provider (rate does not vary by provider) · Wisconsin Medicaid and BadgerCare Plus (fee-for-service, ForwardHealth maximum allowable fees) | $1.86since 2005-10-01 | — | — | Plans negotiate; applies out of network | — | ForwardHealth max fee schedule: Medical- |
| North CarolinaAny qualified provider (rate does not vary by provider) · North Carolina Medicaid Direct (fee-for-service) | $1.77since 2022-01-01 | — | — | Plans must pay at least this | — | NC Medicaid fee schedule 'Local Health D |
| MarylandAny qualified provider (rate does not vary by provider) · Maryland Medicaid (fee-for-service, MDH) | $1.72since 2026-01-01 | — | — | Not classified | — | Maryland Medicaid Professional Services |
| New MexicoAny qualified provider (rate does not vary by provider) · New Mexico Medicaid (fee-for-service, HCA Medical Assistance Division) | $1.68since 2025-01-01 | — | — | Plans must pay at least this | — | New Mexico Medicaid Fee for Service HCPC |
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 J7191?
It depends on the state. Of the 11 states with a published fee-for-service rate, the median is $1.87. Maine pays the most ($5.46) and New Mexico the least ($1.68).
Which state pays the highest Medicaid rate for J7191?
Maine, at $5.46, effective 2026-01-01.
Do managed-care plans pay the same rate for J7191?
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.