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Q5124 Medicaid reimbursement rates by state

Injection, ranibizumab-nuna, biosimilar, (byooviz), 0.1 mg. 24 state Medicaid programs publish a fee-for-service rate for Q5124 at the physician psychologist level. Rates run from $0.00 in Arkansas to $249.49 in Georgia, with a median of $240.97.

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

States publishing
24
Median rate
$240.97units vary by state
Highest
$249.49Georgia
Medicare (non-facility)
—not on the physician fee schedule

Q5124 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
GeorgiaAny qualified provider (rate does not vary by provider) · Georgia Medicaid (fee-for-service)$249.49since 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)$249.49since 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$249.49since 2026-10-01——Plans negotiate; applies out of network—HCA Professional administered drugs fee
KansasAny qualified provider (rate does not vary by provider) · Kansas Medicaid QMB (Qualified Medicare Beneficiary) KMAP fee schedule$249.49since 2026-10-01——Not classified—KMAP Fee Schedule QMB Medicaid (FeeSched
ColoradoAny qualified provider (rate does not vary by provider) · Health First Colorado (Colorado Medicaid, fee-for-service)$241.26since 2026-10-01——Not classified—Q1/Q2/Q3/Q4 2026 PAD Fee Schedule
ArizonaAny qualified provider (rate does not vary by provider) · Arizona AHCCCS fee-for-service (AIHP, Tribal ALTCS, TRBHA and other FFS members)$240.97since 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)$240.97since 2026-07-01——Plans negotiate; applies out of network—Medi-Cal Physician-Administered Drug Rat
North CarolinaAny qualified provider (rate does not vary by provider) · North Carolina Medicaid Direct (fee-for-service)$240.97since 2026-08-01——Plans negotiate; applies out of network—NC Medicaid fee schedule 'Physician Admi
NebraskaAny qualified provider (rate does not vary by provider) · Nebraska Medicaid (fee-for-service)$240.97since 2026-07-01——Plans negotiate; applies out of network—Nebraska Medicaid fee schedule 471-000-5
MichiganAny qualified provider (rate does not vary by provider) · Michigan Medicaid (fee-for-service)$240.97since 2026-07-01——Plans negotiate; applies out of network—MDHHS Practitioner and Medical Clinic Fe
MinnesotaAny qualified provider (rate does not vary by provider) · Minnesota Health Care Programs: Medical Assistance (fee-for-service)$240.97since 2026-07-01——Plans negotiate; applies out of network—MHCP Fee Schedule - Current Fee Schedule
South CarolinaAny qualified provider (rate does not vary by provider) · South Carolina Healthy Connections Medicaid (fee-for-service)$240.97since 2026-07-01——Plans negotiate; applies out of network—SCDHHS Nurse Midwives Fee Schedule (sche
OregonAny qualified provider (rate does not vary by provider) · Oregon Health Plan (fee-for-service, OHA)$240.97since 2026-07-01——Plans negotiate; applies out of network—OHP FFS medical-dental fee schedule (fee
OklahomaAny qualified provider (rate does not vary by provider) · Oklahoma SoonerCare (fee-for-service, OHCA)$240.97since 2026-07-01——State sets the plan rate—SoonerCare Title XIX Fee Schedule
IndianaAny qualified provider (rate does not vary by provider) · Indiana Medicaid (fee-for-service)$237.30since 2023-03-02unit—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)$228.89since 2022-07-01——Plans must pay at least this—Iowa Medicaid fee schedule #02 PHYSICIAN
New JerseyAny qualified provider (rate does not vary by provider) · New Jersey Medicaid / NJ FamilyCare (fee-for-service)$223.74since 2025-01-01——Not classified—NJMMIS Procedure Master Listing CPTHCPCS
VirginiaAny qualified provider (rate does not vary by provider) · Virginia Medicaid (fee-for-service, DMAS)$70.90since 2026-04-01——Plans negotiate; applies out of network—DMAS procedure fee file hcpcmedical.csv
AlabamaAny qualified provider (rate does not vary by provider) · Alabama Medicaid (fee-for-service, Alabama Medicaid Agency fee schedules)$70.90since 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)$68.99since 2026-04-01——Plans negotiate; applies out of network—HFS Practitioner Fee Schedule (effective
ConnecticutAny qualified provider (rate does not vary by provider) · Connecticut Medicaid / HUSKY Health (fee-for-service, CMAP)$60.22since 2026-01-01——Not classified—CMAP fee schedule: Physician Office and
TexasPhysician or licensed psychologist (incl. BCBA-D) · Texas Medicaid (fee-for-service, TMHP)$60.22since 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)$60.22since 2026-01-01——Not classified—Maryland Medicaid Professional Services
ArkansasPhysician or licensed psychologist (incl. BCBA-D) · Arkansas Medicaid (fee-for-service)$0.00since 2025-06-13——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 Q5124?

It depends on the state. Of the 24 states with a published fee-for-service rate, the median is $240.97. Georgia pays the most ($249.49) and Arkansas the least ($0.00).

Which state pays the highest Medicaid rate for Q5124?

Georgia, at $249.49, effective 2026-10-01.

Do managed-care plans pay the same rate for Q5124?

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

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