J7316 Medicaid reimbursement rates by state
Injection, ocriplasmin, 0.125 mg. 21 state Medicaid programs publish a fee-for-service rate for J7316 at the physician psychologist level. Rates run from $93.02 in Maine to $1,178.00 in Montana, with a median of $1,046.93.
Data as of 2026-10-05. Every rate links to the official document it came from.
- States publishing
- 21
- Median rate
- $1,046.93units vary by state
- Highest
- $1,178.00Montana
- Medicare (non-facility)
- —not on the physician fee schedule
J7316 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 |
|---|---|---|---|---|---|---|
| MontanaAny qualified provider (rate does not vary by provider) · Montana Medicaid and HMK Plus (fee-for-service) | $1,178.00since 2025-07-01 | — | — | Not classified | — | Montana Healthcare Programs fee schedule |
| New MexicoAny qualified provider (rate does not vary by provider) · New Mexico Medicaid (fee-for-service, HCA Medical Assistance Division) | $1,109.74since 2025-01-01 | — | — | Plans must pay at least this | — | New Mexico Medicaid Fee for Service HCPC |
| CaliforniaAny qualified provider (rate does not vary by provider) · California Medi-Cal (fee-for-service) | $1,051.39since 2026-10-01 | — | — | Plans negotiate; applies out of network | — | Medi-Cal Rates (Rates files zip: rates_d |
| Rhode IslandAny qualified provider (rate does not vary by provider) · Rhode Island Medicaid (fee-for-service) | $1,046.93since 2021-04-01 | — | — | Plans negotiate; applies out of network | — | RI Medicaid Interactive Fee For Service |
| GeorgiaAny qualified provider (rate does not vary by provider) · Georgia Medicaid (fee-for-service) | $1,046.93since 2019-07-01 | — | — | Plans negotiate; applies out of network | — | PADL- Appendix A - Fee_.xlsx |
| OhioAny qualified provider (rate does not vary by provider) · Ohio Medicaid (fee-for-service) | $1,046.93since 2019-08-01 | — | — | 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 | $1,046.93since 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) | $1,046.93since 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) | $1,046.93since 2019-07-01 | — | — | Plans negotiate; applies out of network | — | ForwardHealth max fee schedule: Medical- |
| MarylandAny qualified provider (rate does not vary by provider) · Maryland Medicaid (fee-for-service, MDH) | $1,046.93since 2026-01-01 | — | — | Not classified | — | Maryland Medicaid Professional Services |
| KansasAny qualified provider (rate does not vary by provider) · Kansas Medicaid QMB (Qualified Medicare Beneficiary) KMAP fee schedule | $1,046.93since 2019-07-01 | — | — | Not classified | — | KMAP Fee Schedule QMB Medicaid (FeeSched |
| VirginiaAny qualified provider (rate does not vary by provider) · Virginia Medicaid (fee-for-service, DMAS) | $1,046.92since 2021-04-01 | — | — | Plans negotiate; applies out of network | — | DMAS procedure fee file hcpcmedical.csv |
| ArkansasPhysician or licensed psychologist (incl. BCBA-D) · Arkansas Medicaid (fee-for-service) | $1,046.75since 2025-06-13 | — | — | Not classified | — | Arkansas Medicaid Physician / CRNA / Fam |
| MinnesotaAny qualified provider (rate does not vary by provider) · Minnesota Health Care Programs: Medical Assistance (fee-for-service) | $1,007.50since 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) | $1,000.31since 2021-07-01 | — | — | Plans must pay at least this | — | Iowa Medicaid fee schedule #02 PHYSICIAN |
| ArizonaAny qualified provider (rate does not vary by provider) · Arizona AHCCCS fee-for-service (AIHP, Tribal ALTCS, TRBHA and other FFS members) | $994.58since 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) | $977.62since 2025-01-01 | — | — | Not classified | — | NJMMIS Procedure Master Listing CPTHCPCS |
| South CarolinaAny qualified provider (rate does not vary by provider) · South Carolina Healthy Connections Medicaid (fee-for-service) | $971.86since 2023-01-01 | — | — | Plans negotiate; applies out of network | — | SCDHHS Nurse Midwives Fee Schedule (sche |
| IdahoAny qualified provider (rate does not vary by provider) · Idaho Medicaid (fee-for-service, Division of Medicaid / Gainwell) | $904.44since 2025-09-01 | — | — | Not classified | — | Idaho Medicaid Numerical Fee Schedule Ju |
| UtahAny qualified provider (rate does not vary by provider) · Utah Medicaid Non-Traditional plan (fee-for-service; reduced benefit plan for some adult expansion members) | $627.62since 2023-07-01 | — | — | Plans negotiate; applies out of network | — | Utah Medicaid Coverage and Reimbursement |
| MaineAny qualified provider (rate does not vary by provider) · MaineCare (fee-for-service) | $93.02since 2023-04-01 | — | — | Not classified | — | MaineCare Section 90 - Drug Rates/Fee Sc |
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 J7316?
It depends on the state. Of the 21 states with a published fee-for-service rate, the median is $1,046.93. Montana pays the most ($1,178.00) and Maine the least ($93.02).
Which state pays the highest Medicaid rate for J7316?
Montana, at $1,178.00, effective 2025-07-01.
Do managed-care plans pay the same rate for J7316?
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.
Related Pharmacy codes
90656Vaccines and immune globulins · 42 states90658Vaccines and immune globulins · 42 states90714Vaccines and immune globulins · 42 states90740Vaccines and immune globulins · 41 states90651Vaccines and immune globulins · 40 states90673Physician-administered drugs (J-codes) · 40 states90653Physician-administered drugs (J-codes) · 40 states90662Physician-administered drugs (J-codes) · 40 states90747Physician-administered drugs (J-codes) · 40 statesQ4101Apligraf, per square centimeter (add-on · 38 statesJ0882Injection, darbepoetin alfa, 1 microgram · 38 statesJ0885Injection, epoetin alfa, (for non-esrd use), 1000 units · 38 states
Track J7316 in your statesYour codes on one rate card: every payer's rule, Medicare comparison, rank and rate changes.