Every state, kept current
The Rates plan
$29/mo7-day free trialThis page shows one representative rate per state for Q5122. 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
30
Median % of Medicare
--
Rate range
$111.16 - $372.88
Q5122 rates in every publishing state
| State | Medicaid rate | % of Medicare | Prior auth | Vintage |
|---|---|---|---|---|
| Alabama | $131.16 | -- | -- | 2026 |
| Arkansas | $372.88 | -- | -- | 2026 |
| Arizona | $111.16 | -- | -- | 2026 |
| California | $137.77 | -- | -- | 2026 |
| Connecticut | $133.05 | -- | -- | 2026 |
| District of Columbia | $133.05 | -- | Not required | 2026 |
| Iowa | $331.27 | -- | -- | 2024 |
| Idaho | $114.96 | -- | Required | 2026 |
| Illinois | $129.71 | -- | -- | 2026 |
| Indiana | $343.44 | -- | -- | 2021 |
| Kansas | $136.91 | -- | -- | 2026 |
| Kentucky | $133.05 | -- | -- | 2026 |
| Michigan | $136.91 | -- | -- | 2026 |
| Minnesota | $134.37 | -- | Required | 2026 |
| Mississippi | $133.31 | -- | -- | 2026 |
| Montana | $133.05 | -- | -- | 2026 |
| Nebraska | $136.91 | -- | -- | 2026 |
| New Hampshire | $327.08 | -- | Not required | 2026 |
| New Jersey | $323.81 | -- | Not required | 2026 |
| New Mexico | $117.01 | -- | -- | 2025 |
| Oklahoma | $136.91 | -- | -- | 2026 |
| Rhode Island | $343.35 | -- | -- | 2026 |
| South Carolina | $134.21 | -- | -- | 2026 |
| Texas | $132.04* | -- | -- | 2026 |
| Utah | $136.91* | -- | Not required | 2026 |
| Virginia | $134.37 | -- | -- | 2026 |
| Vermont | $124.60 | -- | Required | 2026 |
| Washington | $136.91 | -- | -- | 2026 |
| Wisconsin | $136.91 | -- | -- | 2026 |
| Wyoming | $171.38 | -- | -- | 2022 |
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 state-specific services codes
- C1716 - Brachytherapy source, non-stranded, gold-198, per source
- C1717 - Brachytherapy source, non-stranded, high dose rate iridium-192, per source
- C1719 - Brachytherapy source, non-stranded, non-high dose rate iridium-192, per source
- C2616 - Brachytherapy source, non-stranded, yttrium-90, per source
- C2634 - Brachytherapy source, non-stranded, high activity, iodine-125, greater than 1.01 mci (nist), per source
- C2635 - Brachytherapy source, non-stranded, high activity, palladium-103, greater than 2.2 mci (nist), per source
- C2636 - Brachytherapy linear source, non-stranded, palladium-103, per 1 mm
- C2638 - Brachytherapy source, stranded, iodine-125, per source
All 56 codes from Q5098 to Q5167 or every state-specific services code by number.
Frequently asked questions
How much does Medicaid pay for Q5122?
30 state Medicaid programs publish a fee-for-service rate for Q5122 (injection, pegfilgrastim-apgf (nyvepria), biosimilar, 0.5 mg), ranging from $111.16 in Arizona to $372.88 in Arkansas. The full table on this page lists every publishing state's current rate.
Which state pays the most for Q5122?
Arkansas publishes the highest Medicaid rate for Q5122 at $372.88. Arizona publishes the lowest at $111.16.
Does Q5122 require prior authorization under Medicaid?
3 of the 30 publishing states flag Q5122 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".