J2315 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 J2315, 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. 14 of the 39 states list more than one rate for J2315, 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. Of the 39 states, 2 publish J2315 per unit, 1 per encounter and 1 per 1 mg, and 35 schedules print no unit at all (a flat amount per service).
• Per hour. J2315 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 J2315, 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 J2315 run from $3.25 in Arkansas to $1,300.00 in Alabama. The two publish it in different units (encounter versus no unit printed), so part of that gap is the unit rather than the price. Half the states pay more than the median of $4.53 and half pay less. The usual reasons for a spread like this in behavioral health rates:

• Community mental health and substance use services are often billed under H and T codes that each state defines for itself, so the same code can describe a different service in two states.
• Behavioral health is frequently run through a separate state agency, a carve-out or a specialty plan, with its own rate-setting cycle.
• States add enhanced rates for crisis services, certified community behavioral health clinics and integrated care that sit outside the base schedule.

Timing matters too. 31 states set the current rate for J2315 in 2026 or later. A state that has not updated its rate in years will drift down the ranking as others raise theirs.

What a plan pays for J2315 is negotiated privately, but the state decides how much room there is to negotiate. Here is how the rules break down across the 39 states.

In 8 states, the published rate binds plans: a floor, a pass-through or a state-set rate. In 17 states, plans negotiate and the published rate is a benchmark or out-of-network default. In 1 state, the service is paid outside the plans or through a state-directed payment. The rule for the remaining 13 states is not classified yet.

• Plans negotiate; the published rate applies out of network (17 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.
• Plans must pay at least the published rate (7 states). The published rate is your floor. Negotiate up from it, and if a plan pays less, the contract provision is the basis for a payment dispute.
• Paid by the state, outside the plans (1 state). Bill the state's Medicaid program, not the plan, at the published rate. There is no plan contract to negotiate for this service.
• The state sets the plan rate (1 state). There is little to negotiate on price. Contracting is about network participation, authorization and billing terms.

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 Alabama managed care.

J2315 is a HCPCS Level II drug code in the behavioral health line, billed mostly by psychiatrists, psychologists, licensed clinicians and community mental health agencies. J codes cover drugs that are not self-administered. One unit is the dose stated in the code, so a claim for a larger dose bills several units.

Modifiers such as HO (master's level), HN (bachelor's level) and HP (doctoral level) identify the practitioner, and many states publish a different rate for each. Psychotherapy codes are defined by session length, so one unit is one session of the stated duration; H codes are billed in whatever unit the state defines, often 15 minutes, an hour or a day.

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.