Every state, kept current
The Rates plan
$29/mo7-day free trialThis page shows one representative rate per state for J7316. 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
18
Median % of Medicare
--
Rate range
$93.02 - $1,421.83
J7316 rates in every publishing state
| State | Medicaid rate | % of Medicare | Prior auth | Vintage |
|---|---|---|---|---|
| Arkansas | $1,046.75 | -- | -- | 2026 |
| California | $1,051.39 | -- | -- | 2026 |
| District of Columbia | $1,046.93 | -- | Required | 2019 |
| Iowa | $1,000.31 | -- | -- | 2021 |
| Idaho | $904.44 | -- | Not required | 2025 |
| Kansas | $1,046.93 | -- | -- | 2019 |
| Maine | $93.02 | -- | -- | 2026 |
| Michigan | $1,046.93 | -- | -- | 2026 |
| Montana | $1,178.00 | -- | -- | 2026 |
| New Jersey | $977.62 | -- | Not required | 2026 |
| New Mexico | $1,109.74 | -- | -- | 2025 |
| Rhode Island | $1,421.83 | -- | -- | 2026 |
| South Carolina | $971.86 | -- | -- | 2023 |
| Utah | $627.62* | -- | Not required | 2023 |
| Virginia | $1,046.92 | -- | -- | 2021 |
| Washington | $1,046.93 | -- | -- | 2026 |
| Wisconsin | $1,046.93 | -- | -- | 2019 |
| Wyoming | $1,046.93 | -- | -- | 2021 |
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 137 codes from J7030 to J7686 or every drugs code by number.
Frequently asked questions
How much does Medicaid pay for J7316?
18 state Medicaid programs publish a fee-for-service rate for J7316 (injection, ocriplasmin, 0.125 mg), ranging from $93.02 in Maine to $1,421.83 in Rhode Island. The full table on this page lists every publishing state's current rate.
Which state pays the most for J7316?
Rhode Island publishes the highest Medicaid rate for J7316 at $1,421.83. Maine publishes the lowest at $93.02.
Does J7316 require prior authorization under Medicaid?
1 of the 18 publishing states flag J7316 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".