90616 Medicaid reimbursement rate by state (2026)

• Order. States are listed from the highest published rate to the lowest. No single unit is shared by 8 or more states for 90616, so the order is by published amount and is not a like-for-like rank.
• Medicaid rate. The most the state's fee-for-service program pays for one unit, as published. 4 of the 12 states list more than one rate for 90616, by modifier, provider type or setting; the table shows the one that matches the provider level and setting used across states, without add-ons.
• Unit. None of the 12 schedules prints a separate unit for 90616, so each amount is a flat payment for one service as the code defines it.
• Per hour. 90616 is not billed in time units in these states, so no hourly figure is shown.
• Managed-care plans. The rule the state sets for its plans on this rate. What each rule means is explained below.
• % of Medicare. No Medicare physician fee schedule amount is on file for 90616, so there is no percentage.
• Source and date. Each Source link opens the state's own document; “since” is the date the rate took effect.

Published rates for 90616 run from $147.78 in South Carolina to $171.21 in West Virginia, a 1.2x gap in the same unit. Half the states pay more than the median of $171.21 and half pay less. The usual reasons for a spread like this in pharmacy rates:

• For children, many vaccines are supplied through the federal Vaccines for Children program, so the Medicaid payment can be for administration only.
• States differ in whether they pay a fixed fee, a percentage of a benchmark or invoice cost.
• Drugs given in a practice or clinic are commonly priced from a benchmark such as average sales price or wholesale acquisition cost, which moves every quarter.

Timing matters too. 12 states set the current rate for 90616 in 2026 or later. A state that has not updated its rate in years will drift down the ranking as others raise theirs.

No managed-care plan publishes what it pays for 90616. What is public is the rule each state's plan contracts set, and that rule decides how much the published rate matters when you contract with a plan.

In 10 states, plans negotiate and the published rate is a benchmark or out-of-network default. The rule for the remaining 2 states is not classified yet.

• Plans negotiate; the published rate applies out of network (10 states). In-network rates can be above or below the published rate. The published rate is the benchmark both sides know, and the fallback if no contract is signed.

Plan-negotiated rates are never estimated here. To see the rule and its citation for a particular state, open that state's managed-care page, for example West Virginia managed care.

90616 is a CPT medicine code in the pharmacy line, billed mostly by practices and clinics that administer vaccines and drugs. The medicine section runs from vaccines and psychiatry to dialysis, cardiology and therapy. Some of its codes are timed in 15-minute units, others are billed once per session or per test, so the unit matters more here than in most sections.

Drug codes are billed in units of the dose stated in the code, so a larger dose bills more units. Many states require the National Drug Code (NDC) on the claim alongside the billing code.

Before billing, confirm the rate, unit and any modifier with the state's current schedule or the plan: the amounts here are as published, not a guarantee of payment.