J7313 HCPCS code: Injection, fluocinolone acetonide, intravitreal implant (iluvien), 0.01 mg
J7313 is the HCPCS Level II code for injection, fluocinolone acetonide, intravitreal implant (iluvien), 0.01 mg. In 2024 Medicare paid an average of $379.65 per service for J7313 across 17,330 services. Its Medicare coverage code is C (Carrier judgment): Coverage is decided by the Medicare contractor (MAC) case by case. The NCCI unit limit is 38 per day on outpatient hospital claims. Medicare volume fell 18% from 2022 to 2024 (21,183 to 17,330 services). In 2024, about 359 clinicians billed Medicare for J7313 for 746 beneficiaries; Texas, Ohio, California accounted for 33% of services.
Code details
| Field | Value |
|---|---|
| Section | J codes — Drugs administered other than oral method |
| Coverage code | C — Carrier judgment |
| Pricing indicator | 51 — Drug or biological (priced per ASP/average sales price rules) |
| BETOS category | O1E — Other drugs |
| Added | 2016-01-01 |
| Last action effective | 2019-10-01 |
Who bills J7313 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 359 |
| Medicare beneficiaries | 746 |
| States with claims | 24 |
| Share of services in top 3 states (Texas, Ohio, California) | 33% |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for J7313, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 21,183 | 905 | $480.38 | $383.27 |
| 2023 | 20,454 | 867 | $475.26 | $378.73 |
| 2024 | 17,330 | 746 | $476.64 | $379.65 |
States with the most J7313 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| Texas | 2,186 | $381.62 |
| Ohio | 1,767 | $380.63 |
| California | 1,310 | $384.12 |
| Massachusetts | 855 | $384.18 |
| Florida | 817 | $375.22 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 38 | Anatomic Consideration |
| practitioner claims | 38 | Anatomic Consideration |
What changed for J7313
- 2016-01-01: J7313 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 J7313?
J7313 is the HCPCS Level II code for injection, fluocinolone acetonide, intravitreal implant (iluvien), 0.01 mg. Short descriptor: "Inj., iluvien, 0.01 mg".
How much does Medicare pay for J7313?
In 2024, the average Medicare payment was $379.65 per service (average allowed $476.64).
Does Medicare cover J7313?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
How many units of J7313 can be billed per day?
38 on outpatient hospital claims; 38 on practitioner claims (NCCI medically unlikely edits).
Related J73 codes
- J7300 — Intrauterine copper contraceptive (paragard)
- J7301 — Levonorgestrel-releasing intrauterine contraceptive system (skyla), 13.5 mg
- J7302 — Levonorgestrel-releasing intrauterine contraceptive system, 52 mg
- J7303 — Contraceptive supply, hormone containing vaginal ring, each
- J7304 — Contraceptive supply, hormone containing patch, each
- J7306 — Levonorgestrel (contraceptive) implant system, including implants and supplies
- J7307 — Etonogestrel (contraceptive) implant system, including implant and supplies
- J7308 — Aminolevulinic acid hcl for topical administration, 20%, single unit dosage form (354 mg)
- J7309 — Methyl aminolevulinate (mal) for topical administration, 16.8%, 1 gram
- J7310 — Ganciclovir, 4.5 mg, long-acting implant
- J7311 — Injection, fluocinolone acetonide, intravitreal implant (retisert), 0.01 mg
- J7312 — Injection, dexamethasone, intravitreal implant, 0.1 mg
Building a device that would bill under a code like this? Caduvo matches a device description to HCPCS/CPT codes, Medicare coverage and payment, and the FDA pathway in one report.
Next steps
- Run a reimbursement report for a device billed under J7313
- Watch J7313 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J7313
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.