J7316 HCPCS code: Injection, ocriplasmin, 0.125 mg
J7316 is the HCPCS Level II code for injection, ocriplasmin, 0.125 mg. Its Medicare coverage code is C (Carrier judgment): Coverage is decided by the Medicare contractor (MAC) case by case. The NCCI unit limit is 3 per day on outpatient hospital claims.
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 | 2014-01-01 |
| Last action effective | 2024-01-01 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 3 | CMS Policy |
| practitioner claims | 3 | CMS Policy |
What changed for J7316
- 2014-01-01: J7316 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 J7316?
J7316 is the HCPCS Level II code for injection, ocriplasmin, 0.125 mg. Short descriptor: "Inj, ocriplasmin, 0.125 mg".
Does Medicare cover J7316?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
How many units of J7316 can be billed per day?
3 on outpatient hospital claims; 3 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
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Next steps
- Run a reimbursement report for a device billed under J7316
- Watch J7316 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J7316
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.