S0108 Medicaid reimbursement rate by state (2026)
Mercaptopurine, oral, 50 mg. Medicaid pays a median of $1.64 for S0108 across 6 states, from $0.78 in Utah to $6.30 in Nevada.
- States publishing
- 6
- National median
- $1.64units vary by state
- Lowest
- $0.78Utah
- Highest
- $6.30Nevada
What does Medicaid pay for S0108?
6 state Medicaid programs publish a fee-for-service rate for S0108. The national median is $1.64 (units differ between states). Nevada pays the most, $6.30, and Utah the least, $0.78, a 8.1x spread.
S0108 rate by state: highest, middle and lowest
One like-for-like fee-for-service rate per state, ranked. The workspace lists all 6 states with every variant, modifier and effective date.
How to read this table
- Order. States are listed from the highest published rate to the lowest. No single unit is shared by 8 or more states for S0108, so the order is by published amount and is not a like-for-like rank.
- Medicaid rate. The most the state's fee-for-service program pays for one unit, as published. 2 of the 6 states list more than one rate for S0108, by modifier, provider type or setting; the table shows the one that matches the provider level and setting used across states, without add-ons.
- Unit. None of the 6 schedules prints a separate unit for S0108, so each amount is a flat payment for one service as the code defines it.
- Per hour. S0108 is not billed in time units in these states, so no hourly figure is shown.
- Managed-care plans. The rule the state sets for its plans on this rate. What each rule means is explained below.
- % of Medicare. No Medicare physician fee schedule amount is on file for S0108, so there is no percentage.
- Source and date. Each Source link opens the state's own document; “since” is the date the rate took effect.
Why S0108 rates differ between states
Published rates for S0108 run from $0.78 in Utah to $6.30 in Nevada, a 8.1x gap in the same unit. Half the states pay more than the median of $1.64 and half pay less. The usual reasons for a spread like this in pharmacy rates:
- For children, many vaccines are supplied through the federal Vaccines for Children program, so the Medicaid payment can be for administration only.
- States differ in whether they pay a fixed fee, a percentage of a benchmark or invoice cost.
- Drugs given in a practice or clinic are commonly priced from a benchmark such as average sales price or wholesale acquisition cost, which moves every quarter.
Timing matters too. 2 states set the current rate for S0108 in 2026 or later, while 3 states still pay a rate that took effect in 2022 or earlier. A state that has not updated its rate in years will drift down the ranking as others raise theirs.
What managed-care plans pay for S0108
What a plan pays for S0108 is negotiated privately, but the state decides how much room there is to negotiate. Here is how the rules break down across the 6 states.
In 1 state, the published rate binds plans: a floor, a pass-through or a state-set rate. In 4 states, plans negotiate and the published rate is a benchmark or out-of-network default. The rule for the remaining 1 state is not classified yet.
- Plans negotiate; the published rate applies out of network (4 states). In-network rates can be above or below the published rate. The published rate is the benchmark both sides know, and the fallback if no contract is signed.
- Plans must pay at least the published rate (1 state). The published rate is your floor. Negotiate up from it, and if a plan pays less, the contract provision is the basis for a payment dispute.
Plan-negotiated rates are never estimated here. To see the rule and its citation for a particular state, open that state's managed-care page, for example Nevada managed care.
Units and billing for S0108
S0108 is a HCPCS Level II temporary national code in the pharmacy line, billed mostly by practices and clinics that administer vaccines and drugs. S codes were created for private payers and are widely used by Medicaid programs for services Medicare does not cover, such as home nursing and home infusion. Units range from 15 minutes to a day.
Drug codes are billed in units of the dose stated in the code, so a larger dose bills more units. Many states require the National Drug Code (NDC) on the claim alongside the billing code.
Before billing, confirm the rate, unit and any modifier with the state's current schedule or the plan: the amounts here are as published, not a guarantee of payment.
Frequently asked questions
What does Medicaid pay for S0108?
It depends on the state. Of the 6 states with a published fee-for-service rate, the median is $1.64. Nevada pays the most ($6.30) and Utah the least ($0.78).
Which state pays the highest Medicaid rate for S0108?
Nevada, at $6.30, effective 2026-09-01.
Which state pays the lowest Medicaid rate for S0108?
Utah, at $0.78, effective 2022-01-01.
What unit is S0108 billed in?
None of the 6 schedules prints a separate unit for S0108, so each amount is a flat payment for one service as the code defines it.
Do managed-care plans pay the same rate for S0108?
Not necessarily. In 1 state, the published rate binds plans: a floor, a pass-through or a state-set rate. In 4 states, plans negotiate and the published rate is a benchmark or out-of-network default. The rule for the remaining 1 state is not classified yet. Each rule is cited to the plan contract, statute or notice in the workspace.