Every state, kept current
The Rates plan
$29/mo7-day free trialThis page shows one representative rate per state for Q5164. 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
12
Median % of Medicare
--
Rate range
$3.94 - $11.74
Q5164 rates in every publishing state
| State | Medicaid rate | % of Medicare | Prior auth | Vintage |
|---|---|---|---|---|
| Arkansas | $4.83 | -- | -- | 2026 |
| Arizona | $4.23 | -- | -- | 2026 |
| California | $11.74 | -- | -- | 2026 |
| Illinois | $3.94 | -- | -- | 2026 |
| Kansas | $4.23 | -- | -- | 2026 |
| Minnesota | $5.33 | -- | Required | 2026 |
| Nebraska | $4.52 | -- | -- | 2026 |
| New Hampshire | $4.23 | -- | Not required | 2026 |
| Oklahoma | $4.23 | -- | -- | 2026 |
| Utah | $4.23* | -- | Required | 2026 |
| Washington | $9.56 | -- | -- | 2026 |
| Wisconsin | $9.78 | -- | -- | 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 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 Q5164?
12 state Medicaid programs publish a fee-for-service rate for Q5164 (injection, ustekinumab-hmny (starjemza), biosimilar, 1 mg), ranging from $3.94 in Illinois to $11.74 in California. The full table on this page lists every publishing state's current rate.
Which state pays the most for Q5164?
California publishes the highest Medicaid rate for Q5164 at $11.74. Illinois publishes the lowest at $3.94.
Does Q5164 require prior authorization under Medicaid?
2 of the 12 publishing states flag Q5164 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".