Every state, kept current
The Rates plan
$29/mo7-day free trialThis page shows one representative rate per state for J1097. 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
21
Median % of Medicare
--
Rate range
$50.37 - $142.36
J1097 rates in every publishing state
| State | Medicaid rate | % of Medicare | Prior auth | Vintage |
|---|---|---|---|---|
| Arkansas | $92.07* | -- | -- | 2026 |
| Arizona | $92.00 | -- | -- | 2026 |
| California | $118.00 | -- | -- | 2026 |
| District of Columbia | $116.25 | -- | Not required | 2020 |
| Iowa | $119.51 | -- | -- | 2024 |
| Idaho | $80.12 | -- | Not required | 2025 |
| Illinois | $109.76 | -- | -- | 2026 |
| Indiana | $123.90 | -- | -- | 2023 |
| Kentucky | $97.54 | -- | -- | 2026 |
| Michigan | $50.37 | -- | -- | 2026 |
| Minnesota | $118.00 | -- | -- | 2024 |
| Mississippi | $97.54 | -- | -- | 2026 |
| Montana | $96.61 | -- | -- | 2026 |
| Nebraska | $126.02 | -- | -- | 2026 |
| New Hampshire | $118.00 | -- | Not required | 2026 |
| New Mexico | $130.63 | -- | -- | 2025 |
| Rhode Island | $142.36 | -- | -- | 2026 |
| South Carolina | $116.11 | -- | -- | 2023 |
| Utah | $118.00* | -- | Not required | 2024 |
| Washington | $118.00 | -- | -- | 2026 |
| Wisconsin | $116.25 | -- | -- | 2019 |
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 194 codes from J1000 to J1980 or every drugs code by number.
Frequently asked questions
How much does Medicaid pay for J1097?
21 state Medicaid programs publish a fee-for-service rate for J1097 (phenylephrine 10.16 mg/ml and ketorolac 2.88 mg/ml ophthalmic irrigation solution, 1 ml), ranging from $50.37 in Michigan to $142.36 in Rhode Island. The full table on this page lists every publishing state's current rate.
Which state pays the most for J1097?
Rhode Island publishes the highest Medicaid rate for J1097 at $142.36. Michigan publishes the lowest at $50.37.
Does J1097 require prior authorization under Medicaid?
No publishing state flags J1097 with a prior-authorization indicator on its fee schedule. Absence of a flag means the state publishes none, not that PA is never required - confirm through the state's provider manual.