J9395 Medicaid reimbursement rates by state
Injection, fulvestrant, 25 mg. 35 state Medicaid programs publish a fee-for-service rate for J9395 at the physician psychologist level. Rates run from $4.80 in Illinois to $86.93 in New Jersey, with a median of $5.28.
Data as of 2026-10-05. Every rate links to the official document it came from.
- States publishing
- 35
- Median rate
- $5.28units vary by state
- Highest
- $86.93New Jersey
- Medicare (non-facility)
- —not on the physician fee schedule
J9395 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 |
|---|---|---|---|---|---|---|
| New JerseyAny qualified provider (rate does not vary by provider) · New Jersey Medicaid / NJ FamilyCare (fee-for-service) | $86.93⚠ over 3× mediansince 2025-01-01 | — | — | Not classified | — | NJMMIS Procedure Master Listing CPTHCPCS |
| ArkansasPhysician or licensed psychologist (incl. BCBA-D) · Arkansas Medicaid (fee-for-service) | $80.66⚠ over 3× mediansince 2025-06-13 | — | — | Not classified | — | Arkansas Medicaid Physician / CRNA / Fam |
| IowaPhysician or licensed psychologist (incl. BCBA-D) · Iowa Medicaid (fee-for-service schedules; the floor IA Health Link plans must pay) | $16.46⚠ over 3× mediansince 2024-03-01 | — | — | Plans must pay at least this | — | Iowa Medicaid fee schedule #02 PHYSICIAN |
| CaliforniaAny qualified provider (rate does not vary by provider) · California Medi-Cal (fee-for-service) | $9.40since 2026-10-01 | — | — | Plans negotiate; applies out of network | — | Medi-Cal Rates (Rates files zip: rates_d |
| New HampshireAny qualified provider (rate does not vary by provider) · New Hampshire Medicaid (fee-for-service, DHHS / NH MMIS) | $8.75since 2025-07-01 | — | — | Plans negotiate; applies out of network | — | 2026 Fee Schedule - Covered Procedures R |
| New MexicoAny qualified provider (rate does not vary by provider) · New Mexico Medicaid (fee-for-service, HCA Medical Assistance Division) | $6.66since 2025-04-01 | — | — | Plans must pay at least this | — | New Mexico Medicaid Fee for Service HCPC |
| VermontAny qualified provider (rate does not vary by provider) · Vermont Medicaid (fee-for-service, DVHA) | $6.39since 2026-01-01 | — | — | Not classified | — | Vermont Medicaid Fee Schedule - HCPCS (i |
| TexasPhysician or licensed psychologist (incl. BCBA-D) · Texas Medicaid (fee-for-service, TMHP) | $5.72since 2026-09-01 | — | — | Plans negotiate; applies out of network | — | TMHP Texas Medicaid Fee Schedule - Physi |
| MarylandAny qualified provider (rate does not vary by provider) · Maryland Medicaid (fee-for-service, MDH) | $5.72since 2026-01-01 | — | — | Not classified | — | Maryland Medicaid Professional Services |
| UtahAny qualified provider (rate does not vary by provider) · Utah Medicaid (fee-for-service, Traditional plan) | $5.62since 2026-10-01 | — | — | Plans negotiate; applies out of network | — | Utah Medicaid Coverage and Reimbursement |
| North CarolinaAny qualified provider (rate does not vary by provider) · North Carolina Medicaid Direct (fee-for-service) | $5.28since 2026-08-01 | — | — | Plans must pay at least this | — | NC Medicaid fee schedule 'Local Health D |
| South CarolinaAny qualified provider (rate does not vary by provider) · South Carolina Healthy Connections Medicaid (fee-for-service) | $5.28since 2026-07-01 | — | — | Not classified | — | SCDHHS Infusion Center Fee Schedule (sch |
| MontanaAny qualified provider (rate does not vary by provider) · Montana Medicaid and HMK Plus (fee-for-service) | $5.28since 2026-07-01 | — | — | Not classified | — | Montana Healthcare Programs fee schedule |
| ArizonaAny qualified provider (rate does not vary by provider) · Arizona AHCCCS fee-for-service (AIHP, Tribal ALTCS, TRBHA and other FFS members) | $5.28since 2026-08-01 | — | — | Plans negotiate; applies out of network | — | AHCCCS FFS Capped Fee Schedule: Physicia |
| OregonAny qualified provider (rate does not vary by provider) · Oregon Health Plan (fee-for-service, OHA) | $5.28since 2026-07-01 | — | — | Plans negotiate; applies out of network | — | OHP FFS medical-dental fee schedule (fee |
| MichiganAny qualified provider (rate does not vary by provider) · Michigan Medicaid (fee-for-service) | $5.28since 2026-07-01 | — | — | Plans negotiate; applies out of network | — | MDHHS Practitioner and Medical Clinic Fe |
| LouisianaAny qualified provider (rate does not vary by provider) · Louisiana Medicaid (fee-for-service) | $5.28since 2026-07-01 | — | — | Plans must pay at least this | — | Louisiana Medicaid Professional Services |
| OklahomaAny qualified provider (rate does not vary by provider) · Oklahoma SoonerCare (fee-for-service, OHCA) | $5.28since 2026-07-01 | — | — | State sets the plan rate | — | SoonerCare Title XIX Fee Schedule |
| NevadaPhysician or licensed psychologist (incl. BCBA-D) · Nevada Medicaid (fee-for-service provider-type reimbursement schedules) | $5.28since 2026-09-01 | — | — | Plans must pay at least this | — | Physician Administered Drug (PAD) Pricin |
| MaineAny qualified provider (rate does not vary by provider) · MaineCare (fee-for-service) | $5.28since 2026-07-01 | — | — | Not classified | — | MaineCare Section 90 - Drug Rates/Fee Sc |
| NebraskaAny qualified provider (rate does not vary by provider) · Nebraska Medicaid (fee-for-service) | $5.27since 2026-07-01 | — | — | Plans negotiate; applies out of network | — | Nebraska Medicaid fee schedule 471-000-5 |
| MinnesotaAny qualified provider (rate does not vary by provider) · Minnesota Health Care Programs: Medical Assistance (fee-for-service) | $5.27since 2026-07-01 | — | — | Plans negotiate; applies out of network | — | MHCP Fee Schedule - Current Fee Schedule |
| VirginiaAny qualified provider (rate does not vary by provider) · Virginia Medicaid (fee-for-service, DMAS) | $5.27since 2026-07-01 | — | — | Plans negotiate; applies out of network | — | DMAS procedure fee file hcpcmedical.csv |
| IndianaAny qualified provider (rate does not vary by provider) · Indiana Medicaid (fee-for-service) | $5.25since 2025-10-01 | unit | — | Plans must pay at least this | — | IHCP Professional Fee Schedule (Last Upd |
| West VirginiaAny qualified provider (rate does not vary by provider) · West Virginia Medicaid (fee-for-service, Bureau for Medical Services) | $5.02since 2026-10-01 | 25 MG | — | Plans negotiate; applies out of network | — | BMS Physician Administered Drug ASP Pric |
| GeorgiaAny qualified provider (rate does not vary by provider) · Georgia Medicaid (fee-for-service) | $5.02since 2026-10-01 | — | — | Plans negotiate; applies out of network | — | PADL Fee Schedule -Published Copy - Octo |
| OhioAny qualified provider (rate does not vary by provider) · Ohio Medicaid (fee-for-service) | $5.02since 2026-10-01 | — | — | 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 | $5.02since 2026-10-01 | — | — | Plans negotiate; applies out of network | — | HCA Professional administered drugs fee |
| WisconsinAny qualified provider (rate does not vary by provider) · Wisconsin Medicaid and BadgerCare Plus (fee-for-service, ForwardHealth maximum allowable fees) | $5.02since 2026-10-01 | — | — | Plans negotiate; applies out of network | — | ForwardHealth max fee schedule: Medical- |
| KansasAny qualified provider (rate does not vary by provider) · Kansas Medicaid QMB (Qualified Medicare Beneficiary) KMAP fee schedule | $5.02since 2026-10-01 | — | — | Not classified | — | KMAP Fee Schedule QMB Medicaid (FeeSched |
| IdahoAny qualified provider (rate does not vary by provider) · Idaho Medicaid (fee-for-service, Division of Medicaid / Gainwell) | $4.94since 2026-07-01 | — | — | Not classified | — | Idaho Medicaid Numerical Fee Schedule Ju |
| MississippiAny qualified provider (rate does not vary by provider) · Mississippi Medicaid (fee-for-service) | $4.94since 2026-07-01 | — | — | Plans must pay at least this | — | DOM Comprehensive Fee Schedule, Septembe |
| AlabamaAny qualified provider (rate does not vary by provider) · Alabama Medicaid (fee-for-service, Alabama Medicaid Agency fee schedules) | $4.94since 2026-08-25 | — | — | Not classified | — | Physician Drug Fee Schedule (REF-0130-Q) |
| ColoradoAny qualified provider (rate does not vary by provider) · Health First Colorado (Colorado Medicaid, fee-for-service) | $4.86since 2026-10-01 | — | — | Not classified | — | Q1/Q2/Q3/Q4 2026 PAD Fee Schedule |
| IllinoisAny qualified provider (rate does not vary by provider) · Illinois Medicaid (HFS fee-for-service) | $4.80since 2026-04-01 | — | — | Plans negotiate; applies out of network | — | HFS Practitioner Fee Schedule (effective |
Rates marked ⚠ are more than three times the median for the same unit; they are published as shown but often reflect an office (non-facility) fee or a different scope of service. 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 J9395?
It depends on the state. Of the 35 states with a published fee-for-service rate, the median is $5.28. New Jersey pays the most ($86.93) and Illinois the least ($4.80).
Which state pays the highest Medicaid rate for J9395?
New Jersey, at $86.93, effective 2025-01-01.
Do managed-care plans pay the same rate for J9395?
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 J9395 in your statesYour codes on one rate card: every payer's rule, Medicare comparison, rank and rate changes.