Every state, kept current
The Rates plan
$29/mo7-day free trialThis page shows one representative rate per state for J0738. Full schedules include every locality, modifier, and age-band variant.
- Every code on all 51 published schedules
- Full-schedule CSV export and state network lists
- Email alerts when a state changes its rates
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Publishing states
25
Median % of Medicare
--
Rate range
$11.63 - $20.56
J0738 rates in every publishing state
| State | Medicaid rate | % of Medicare | Prior auth | Vintage |
|---|---|---|---|---|
| Arkansas | $16.13 | -- | -- | 2026 |
| Arizona | $15.32 | -- | -- | 2026 |
| California | $20.56 | -- | -- | 2026 |
| Connecticut | $16.13 | -- | -- | 2026 |
| District of Columbia | $16.13 | -- | Not required | 2026 |
| Idaho | $13.94 | -- | Not required | 2026 |
| Illinois | $15.67 | -- | -- | 2026 |
| Indiana | $15.98 | -- | -- | 2025 |
| Kansas | $16.08 | -- | -- | 2026 |
| Maine | $16.08 | -- | -- | 2026 |
| Michigan | $16.08 | -- | -- | 2026 |
| Minnesota | $16.08 | -- | -- | 2026 |
| Mississippi | $16.10 | -- | -- | 2026 |
| Montana | $16.13 | -- | -- | 2026 |
| Nebraska | $16.08 | -- | -- | 2026 |
| New Hampshire | $15.22 | -- | Not required | 2026 |
| New Jersey | $15.08 | -- | Not required | 2026 |
| Oklahoma | $16.08 | -- | -- | 2026 |
| Rhode Island | $16.66 | -- | -- | 2026 |
| Texas | $11.63* | -- | -- | 2025 |
| Utah | $16.08* | -- | Required | 2026 |
| Virginia | $16.08 | -- | -- | 2026 |
| Vermont | $15.33 | -- | -- | 2026 |
| Washington | $16.08 | -- | -- | 2026 |
| Wisconsin | $16.08 | -- | -- | 2026 |
Published Medicaid fee-for-service schedule amounts, not a coverage or eligibility guarantee. Managed-care plan rates can differ. Where no prior-authorization flag is shown, the state does not publish one. Rows marked * are representative published variants or methodology-derived rates. "--" in the prior-auth column means the state publishes no PA flag.
Related drugs codes
- J0013 - Esketamine, nasal spray, 1 mg
- J0120 - Injection, tetracycline, up to 250 mg
- J0121 - Injection, omadacycline, 1 mg
- J0122 - Injection, eravacycline, 1 mg
- J0129 - Injection, abatacept, 10 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered)
- J0130 - Injection abciximab, 10 mg
- J0131 - Injection, acetaminophen, not otherwise specified,10 mg
- J0132 - Injection, acetylcysteine, 100 mg
All 224 codes from J0013 to J0911 or every drugs code by number.
Frequently asked questions
How much does Medicaid pay for J0738?
25 state Medicaid programs publish a fee-for-service rate for J0738 (injection, lenacapavir, 1 mg, fda approved prescription, only for use as hiv pre-exposure prophylaxis (not for use as treatment for hiv)), ranging from $11.63 in Texas to $20.56 in California. The full table on this page lists every publishing state's current rate.
Which state pays the most for J0738?
California publishes the highest Medicaid rate for J0738 at $20.56. Texas publishes the lowest at $11.63.
Does J0738 require prior authorization under Medicaid?
1 of the 25 publishing states flag J0738 as requiring prior authorization (always or conditionally) on their fee schedules. States without a flag publish no PA indicator for this code - that means "not published", not "no PA required".