Every state, kept current
The Rates plan
$29/mo7-day free trialThis page shows one representative rate per state for J1438. 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
$180.50 - $1,143.50
J1438 rates in every publishing state
| State | Medicaid rate | % of Medicare | Prior auth | Vintage |
|---|---|---|---|---|
| Alabama | $801.23 | -- | -- | 2026 |
| Arkansas | $751.24* | -- | -- | 2026 |
| Arizona | $1,070.69 | -- | -- | 2026 |
| Iowa | $892.45 | -- | -- | 2024 |
| Idaho | $304.22 | -- | Not required | 2025 |
| Indiana | $1,124.22 | -- | -- | 2026 |
| Kansas | $1,070.69 | -- | -- | 2026 |
| Kentucky | $790.78 | -- | -- | 2026 |
| Maine | $1,080.88 | -- | -- | 2026 |
| Michigan | $411.71 | -- | -- | 2026 |
| Minnesota | $842.40 | -- | -- | 2026 |
| Mississippi | $1,070.69 | -- | -- | 2026 |
| Montana | $1,080.88 | -- | -- | 2026 |
| Nebraska | $1,143.50 | -- | -- | 2026 |
| New Hampshire | $1,070.69 | -- | Required | 2026 |
| New Jersey | $180.50 | -- | Not required | 2026 |
| New Mexico | $436.41 | -- | -- | 2025 |
| Oklahoma | $411.71 | -- | -- | 2026 |
| Rhode Island | $230.34 | -- | -- | 2026 |
| South Carolina | $1,053.55 | -- | -- | 2026 |
| Texas | $1,040.09* | -- | -- | 2025 |
| Utah | $1,008.73* | -- | Required | 2026 |
| Virginia | $411.71 | -- | -- | 2016 |
| Washington | $1,038.12 | -- | -- | 2026 |
| Wisconsin | $411.71 | -- | -- | 2016 |
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 J1438?
25 state Medicaid programs publish a fee-for-service rate for J1438 (injection, etanercept, 25 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)), ranging from $180.50 in New Jersey to $1,143.50 in Nebraska. The full table on this page lists every publishing state's current rate.
Which state pays the most for J1438?
Nebraska publishes the highest Medicaid rate for J1438 at $1,143.50. New Jersey publishes the lowest at $180.50.
Does J1438 require prior authorization under Medicaid?
2 of the 25 publishing states flag J1438 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".