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Billing code J9332 · Pharmacy

J9332 Medicaid reimbursement rate by state (2026)

Injection, efgartigimod alfa-fcab, 2mg. Medicaid pays a median of $32.35 for J9332 across 36 states, from $27.84 in Idaho to $36.23 in Utah.

Data as of Oct 5, 202636 statesEvery rate links to its official source

States publishing
36
National median
$32.35units vary by state
Lowest
$27.84Idaho
Highest
$36.23Utah
Answer

What does Medicaid pay for J9332?

36 state Medicaid programs publish a fee-for-service rate for J9332. The national median is $32.35 (units differ between states). Utah pays the most, $36.23, and Idaho the least, $27.84, a 1.3x spread.

State ranking

J9332 rate by state: highest, middle and lowest

One like-for-like fee-for-service rate per state, ranked. The workspace lists all 36 states with every variant, modifier and effective date.

#StateMedicaid rateUnitPer hourManaged-care plans% of Medicare
1Utah Source · since 2026-10-01$36.23——Plans negotiate; applies out of network—
2Indiana Source · since 2026-01-01$33.15unit—Plans must pay at least this—
3Alabama Source · since 2026-08-25$32.61——Not classified—
18South Dakota Source · since 2026-10-01$32.35——Not classified—
19West Virginia Source · since 2026-10-01$32.352 MG—Plans negotiate; applies out of network—
20Montana Source · since 2026-01-01$32.22——Not classified—
35New Jersey Source · since 2025-01-01$29.45——Not classified—
36Idaho Source · since 2026-07-01$27.84——Not classified—
See all 36 states for J9332 — start free

28 more states, with every modifier and provider-type variant, rate history and the plan rule in each state. 14-day free trial, no credit card.

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Rates are per the unit shown for each state; units can differ between states. Medicare amounts are computed from the CMS relative value file and locality cost indices; states with several Medicare localities show a range. Confirm rates with the payer before billing.

Track J9332 in your states. Get an alert when any state changes it, with every variant and the managed-care rule.
Guide

How to read this table

  • Order. States are listed from the highest published rate to the lowest. No single unit is shared by 8 or more states for J9332, 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. 12 of the 36 states list more than one rate for J9332, 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 36 states, 1 publish J9332 per unit and 1 per 2 mg, and 34 schedules print no unit at all (a flat amount per service).
  • Per hour. J9332 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 J9332, 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.
Context

Why J9332 rates differ between states

Published rates for J9332 run from $27.84 in Idaho to $36.23 in Utah, a 1.3x gap in the same unit. Half the states pay more than the median of $32.35 and half pay less. The usual reasons for a spread like this in pharmacy rates:

  • 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.
  • 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.

Timing matters too. 31 states set the current rate for J9332 in 2026 or later. A state that has not updated its rate in years will drift down the ranking as others raise theirs.

Managed care

What managed-care plans pay for J9332

No managed-care plan publishes what it pays for J9332. 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 6 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. 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 (5 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.
  • 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 Utah managed care.

Billing

Units and billing for J9332

J9332 is a HCPCS Level II drug code in the pharmacy line, billed mostly by practices and clinics that administer vaccines and drugs. 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.

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

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.

FAQ

Frequently asked questions

What does Medicaid pay for J9332?

It depends on the state. Of the 36 states with a published fee-for-service rate, the median is $32.35. Utah pays the most ($36.23) and Idaho the least ($27.84).

Which state pays the highest Medicaid rate for J9332?

Utah, at $36.23, effective 2026-10-01.

Which state pays the lowest Medicaid rate for J9332?

Idaho, at $27.84, effective 2026-07-01.

What unit is J9332 billed in?

Of the 36 states, 1 publish J9332 per unit and 1 per 2 mg, and 34 schedules print no unit at all (a flat amount per service).

Do managed-care plans pay the same rate for J9332?

Not necessarily. In 6 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. The rule for the remaining 13 states is not classified yet. Each rule is cited to the plan contract, statute or notice in the workspace.