J3316 HCPCS code: Injection, triptorelin, extended-release, 3.75 mg
J3316 is the HCPCS Level II code for injection, triptorelin, extended-release, 3.75 mg. Its Medicare coverage code is D (Special coverage instructions apply): Medicare covers it when its national or local coverage criteria are met. The NCCI unit limit is 6 per day on outpatient hospital claims.
Code details
| Field | Value |
|---|---|
| Section | J codes — Drugs administered other than oral method |
| Coverage code | D — Special coverage instructions apply |
| Pricing indicator | 51 — Drug or biological (priced per ASP/average sales price rules) |
| BETOS category | O1E — Other drugs |
| Added | 2019-01-01 |
| Last action effective | 2019-01-01 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 6 | Prescribing Information |
| practitioner claims | 6 | Prescribing Information |
Medicare policy articles for this code
- A52453: Billing and Coding: Luteinizing Hormone-Releasing Hormone (LHRH) Analogs (Wellpoint Federal (MAC - Part A, MAC - Part B))
Covered diagnoses (207 ICD-10-CM codes)
The diagnoses most often listed as covered in the policy articles above:
| ICD-10-CM | Diagnosis | Articles listing it |
|---|---|---|
| C07 | Malignant neoplasm of parotid gland | 1 |
| C08.0 | Malignant neoplasm of submandibular gland | 1 |
| C08.1 | Malignant neoplasm of sublingual gland | 1 |
| C48.1 | Malignant neoplasm of specified parts of peritoneum | 1 |
| C48.8 | Malignant neoplasm of overlapping sites of retroperitoneum and peritoneum | 1 |
| C50.011 | Malignant neoplasm of nipple and areola, right female breast | 1 |
| C50.012 | Malignant neoplasm of nipple and areola, left female breast | 1 |
| C50.021 | Malignant neoplasm of nipple and areola, right male breast | 1 |
| C50.022 | Malignant neoplasm of nipple and areola, left male breast | 1 |
| C50.111 | Malignant neoplasm of central portion of right female breast | 1 |
Showing 10 of 207. The full list, non-covered diagnoses and CSV export are in Caduvo.
What changed for J3316
- 2019-01-01: J3316 added to HCPCS Level II
- Next scheduled CMS quarterly update (HCPCS and DMEPOS fee schedule): 2027-01-01
Frequently asked questions
What is HCPCS code J3316?
J3316 is the HCPCS Level II code for injection, triptorelin, extended-release, 3.75 mg. Short descriptor: "Inj., triptorelin xr 3.75 mg".
Does Medicare cover J3316?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
Which diagnoses support coverage for J3316?
Medicare policy articles that cite J3316 list 207 covered ICD-10-CM diagnosis codes across 1 article. The most cited include C07 (Malignant neoplasm of parotid gland), C08.0 (Malignant neoplasm of submandibular gland), C08.1 (Malignant neoplasm of sublingual gland). A listed diagnosis is necessary but not sufficient; the policy's other criteria still apply.
How many units of J3316 can be billed per day?
6 on outpatient hospital claims; 6 on practitioner claims (NCCI medically unlikely edits).
Related J33 codes
- J3300 — Injection, triamcinolone acetonide, preservative free, 1 mg
- J3301 — Injection, triamcinolone acetonide, not otherwise specified, 10 mg
- J3302 — Injection, triamcinolone diacetate, per 5 mg
- J3303 — Injection, triamcinolone hexacetonide, per 5 mg
- J3304 — Injection, triamcinolone acetonide, preservative-free, extended-release, microsphere formulation, 1 mg
- J3305 — Injection, trimetrexate glucuronate, per 25 mg
- J3310 — Injection, perphenazine, up to 5 mg
- J3315 — Injection, triptorelin pamoate, 3.75 mg
- J3320 — Injection, spectinomycin dihydrochloride, up to 2 gm
- J3350 — Injection, urea, up to 40 gm
- J3355 — Injection, urofollitropin, 75 iu
- J3357 — Ustekinumab, for subcutaneous injection, 1 mg
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Next steps
- Run a reimbursement report for a device billed under J3316
- Watch J3316 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J3316
Sources: CMS HCPCS Level II release October 2025; CMS DMEPOS fee schedule; CMS NCCI MUE tables; CMS Medicare utilization (physician and DME supplier files); CMS Medicare Coverage Database articles. Fees are Medicare allowables, not commercial rates. Not billing or legal advice.