MedicaidRateStart free trial

Q5112 Medicaid reimbursement rates by state

Injection, trastuzumab-dttb, biosimilar, (ontruzant), 10 mg. 35 state Medicaid programs publish a fee-for-service rate for Q5112 at the physician psychologist level. Rates run from $0.00 in Arkansas to $92.73 in Indiana, with a median of $27.27.

Data as of 2026-10-05. Every rate links to the official document it came from.

States publishing
35
Median rate
$27.27units vary by state
Highest
$92.73Indiana
Medicare (non-facility)
—not on the physician fee schedule

Q5112 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.

StateMedicaid rateUnitPer hourManaged-care plans% of MedicareSource
IndianaAny qualified provider (rate does not vary by provider) · Indiana Medicaid (fee-for-service)$92.73since 2020-07-16unit—Plans must pay at least this—IHCP Professional Fee Schedule (Last Upd
IowaPhysician or licensed psychologist (incl. BCBA-D) · Iowa Medicaid (fee-for-service schedules; the floor IA Health Link plans must pay)$89.44⚠ over 3× mediansince 2024-03-01——Plans must pay at least this—Iowa Medicaid fee schedule #02 PHYSICIAN
New HampshireAny qualified provider (rate does not vary by provider) · New Hampshire Medicaid (fee-for-service, DHHS / NH MMIS)$88.31⚠ over 3× mediansince 2024-07-01——Plans negotiate; applies out of network—2026 Fee Schedule - Covered Procedures R
WyomingAny qualified provider (rate does not vary by provider) · Wyoming Medicaid (fee-for-service, Department of Health)$63.12since 2022-10-01——Not classified—Wyoming Medicaid Downloadable Fee Schedu
UtahAny qualified provider (rate does not vary by provider) · Utah Medicaid (fee-for-service, Traditional plan)$36.72since 2026-10-01——Plans negotiate; applies out of network—Utah Medicaid Coverage and Reimbursement
New JerseyAny qualified provider (rate does not vary by provider) · New Jersey Medicaid / NJ FamilyCare (fee-for-service)$36.04since 2025-01-01——Not classified—NJMMIS Procedure Master Listing CPTHCPCS
West VirginiaAny qualified provider (rate does not vary by provider) · West Virginia Medicaid (fee-for-service, Bureau for Medical Services)$32.79since 2026-10-0110 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)$32.79since 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)$32.79since 2026-10-01——Plans negotiate; applies out of network—ODM provider-administered pharmaceutical
WisconsinAny qualified provider (rate does not vary by provider) · Wisconsin Medicaid and BadgerCare Plus (fee-for-service, ForwardHealth maximum allowable fees)$32.79since 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$32.79since 2026-10-01——Not classified—KMAP Fee Schedule QMB Medicaid (FeeSched
South DakotaAny qualified provider (rate does not vary by provider) · South Dakota Medicaid (fee-for-service, DSS Division of Medical Services)$32.79since 2026-10-01——Not classified—South Dakota Medicaid Drugs and Biologic
ColoradoAny qualified provider (rate does not vary by provider) · Health First Colorado (Colorado Medicaid, fee-for-service)$31.71since 2026-10-01——Not classified—Q1/Q2/Q3/Q4 2026 PAD Fee Schedule
AlabamaAny qualified provider (rate does not vary by provider) · Alabama Medicaid (fee-for-service, Alabama Medicaid Agency fee schedules)$29.81since 2026-08-25——Not classified—Physician Drug Fee Schedule (REF-0130-Q)
IllinoisAny qualified provider (rate does not vary by provider) · Illinois Medicaid (HFS fee-for-service)$29.00since 2026-04-01——Plans negotiate; applies out of network—HFS Practitioner Fee Schedule (effective
TexasPhysician or licensed psychologist (incl. BCBA-D) · Texas Medicaid (fee-for-service, TMHP)$27.27since 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)$27.27since 2026-01-01——Not classified—Maryland Medicaid Professional Services
ConnecticutAny qualified provider (rate does not vary by provider) · Connecticut Medicaid / HUSKY Health (fee-for-service, CMAP)$27.27since 2026-01-01——Not classified—CMAP fee schedule: Physician Office and
New MexicoAny qualified provider (rate does not vary by provider) · New Mexico Medicaid (fee-for-service, HCA Medical Assistance Division)$26.37since 2025-04-01——Plans must pay at least this—New Mexico Medicaid Fee for Service HCPC
IdahoAny qualified provider (rate does not vary by provider) · Idaho Medicaid (fee-for-service, Division of Medicaid / Gainwell)$23.56since 2026-07-01——Not classified—Idaho Medicaid Numerical Fee Schedule Ju
North CarolinaAny qualified provider (rate does not vary by provider) · North Carolina Medicaid Direct (fee-for-service)$20.99since 2026-08-01——Plans negotiate; applies out of network—NC Medicaid fee schedule 'Physician Admi
South CarolinaAny qualified provider (rate does not vary by provider) · South Carolina Healthy Connections Medicaid (fee-for-service)$20.99since 2026-07-01——Not classified—SCDHHS Infusion Center Fee Schedule (sch
CaliforniaAny qualified provider (rate does not vary by provider) · California Medi-Cal (fee-for-service)$20.99since 2026-07-01——Plans negotiate; applies out of network—Medi-Cal Physician-Administered Drug Rat
MontanaAny qualified provider (rate does not vary by provider) · Montana Medicaid and HMK Plus (fee-for-service)$20.99since 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)$20.99since 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)$20.99since 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)$20.99since 2026-07-01——Plans negotiate; applies out of network—MDHHS Practitioner and Medical Clinic Fe
OklahomaAny qualified provider (rate does not vary by provider) · Oklahoma SoonerCare (fee-for-service, OHCA)$20.99since 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)$20.99since 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)$20.99since 2026-07-01——Not classified—MaineCare Fee Schedule (MaineCare UCR, H
NebraskaAny qualified provider (rate does not vary by provider) · Nebraska Medicaid (fee-for-service)$20.98since 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)$20.98since 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)$20.98since 2026-07-01——Plans negotiate; applies out of network—DMAS procedure fee file hcpcmedical.csv
VermontAny qualified provider (rate does not vary by provider) · Vermont Medicaid (fee-for-service, DVHA)$18.05since 2026-01-01——Not classified—Vermont Medicaid Fee Schedule - HCPCS (i
ArkansasAny qualified provider (rate does not vary by provider) · Arkansas Medicaid (fee-for-service)$0.00since 2025-06-13——Not classified—Arkansas Medicaid Nurse Practitioner Fee

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 Q5112?

It depends on the state. Of the 35 states with a published fee-for-service rate, the median is $27.27. Indiana pays the most ($92.73 per unit) and Arkansas the least ($0.00).

Which state pays the highest Medicaid rate for Q5112?

Indiana, at $92.73 per unit, effective 2020-07-16.

Do managed-care plans pay the same rate for Q5112?

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

90714Vaccines and immune globulins · 45 states90740Vaccines and immune globulins · 44 states90656Vaccines and immune globulins · 43 states90658Vaccines and immune globulins · 43 states90651Vaccines and immune globulins · 42 states90653Physician-administered drugs (J-codes) · 42 states90662Physician-administered drugs (J-codes) · 42 states90747Physician-administered drugs (J-codes) · 42 states90673Physician-administered drugs (J-codes) · 41 statesQ4101Apligraf, per square centimeter (add-on · 40 statesJ0882Injection, darbepoetin alfa, 1 microgram · 40 statesJ0885Injection, epoetin alfa, (for non-esrd use), 1000 units · 40 states
Track Q5112 in your statesYour codes on one rate card: every payer's rule, Medicare comparison, rank and rate changes.
Start free trialPricing
Medicaid rates by state
AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming