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HCPCS code J7313: Iluvien implant, per 0.01 mg2026 Medicare rate & RVUs

Reports fluocinolone acetonide in the Iluvien intravitreal implant, generally used to treat diabetic macular edema, in 0.01-mg units.

CMS RVU26DEffective Oct 1, 2026109 payment localities

Medicare rate · J7313

Iluvien implant, per 0.01 mg

Office or facility?

Work RVUs
0
Total RVUs
0.00
Global days
XXX

National rate · 2026

—

Not priced in the facility setting.

See every locality for J7313 →Billed by an NP, PA or therapist? →

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

Your location

Medicare pays by the payment locality where the service is performed.

On this page 10 sections
  1. Medicare rate
  2. What J7313 covers
  3. By payment locality
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Similar codes
  8. Related codes
  9. Billing questions
  10. Sources

What J7313 covers

J7313 identifies fluocinolone acetonide supplied as the Iluvien intravitreal implant. An ophthalmologist, commonly a retina specialist, places the implant into the vitreous using an applicator. Its corticosteroid is released over time, and its established use includes treatment of diabetic macular edema. The drug code represents the implant product, not the eye procedure used to place it; the applicable intravitreal procedure code may be reported separately when supported by the service.

CMS assigns this code physician fee schedule status E, meaning it is excluded from the physician fee schedule. When Medicare covers the item or service, payment is made under another payment method. HCPCS classifies it as a Part B drug, generally priced from CMS’s quarterly Average Sales Price drug files when covered. Coverage is left to the Medicare contractor’s judgment. Each billing unit represents 0.01 mg of fluocinolone; the 0.19-mg implant corresponds to 19 units.

This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.

Where J7313 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

J7313 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailableUnavailable
AlaskaUnavailableUnavailable
ArizonaUnavailableUnavailable
ArkansasUnavailableUnavailable
Atlanta, GAUnavailableUnavailable
Austin, TXUnavailableUnavailable
Bakersfield, CAUnavailableUnavailable
Baltimore area, MDUnavailableUnavailable
Beaumont, TXUnavailableUnavailable
Brazoria, TXUnavailableUnavailable

J7313 rates by state

Office rate range in each state. Select a state to see its payment localities.

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

Explore a state

Local rates. Clear comparisons.

Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.

View every state and territory as a table
J7313 office rate range by state
State / territoryOffice rate rangeLocalities
AKNo published base rate1
ALNo published base rate1
ARNo published base rate1
AZNo published base rate1
CANo published base rate29
CONo published base rate1
CTNo published base rate1
DCNo published base rate1
DENo published base rate1
FLNo published base rate3
GANo published base rate2
GUNo published base rate1
HINo published base rate1
IANo published base rate1
IDNo published base rate1
ILNo published base rate4
INNo published base rate1
KSNo published base rate1
KYNo published base rate1
LANo published base rate2
MANo published base rate2
MDNo published base rate3
MENo published base rate2
MINo published base rate2
MNNo published base rate1
MONo published base rate3
MSNo published base rate1
MTNo published base rate1
NCNo published base rate1
NDNo published base rate1
NENo published base rate1
NHNo published base rate1
NJNo published base rate2
NMNo published base rate1
NVNo published base rate1
NYNo published base rate5
OHNo published base rate1
OKNo published base rate1
ORNo published base rate2
PANo published base rate2
PRNo published base rate1
RINo published base rate1
SCNo published base rate1
SDNo published base rate1
TNNo published base rate1
TXNo published base rate8
UTNo published base rate1
VANo published base rate2
VINo published base rate1
VTNo published base rate1
WANo published base rate2
WINo published base rate1
WVNo published base rate1
WYNo published base rate1

How the J7313 rate is calculated

Each of J7313’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.

How the rate is built · J7313

RVUs × geographic indexes × conversion factor

Office or facility?

Work0.00

0.00 RVUs× 1.000 GPCI

Practice expense0.00

0.00 RVUs× 1.000 GPCI

Malpractice0.00

0.00 RVUs× 1.000 GPCI

Adjusted RVUs

0.0000

Conversion factor

$33.4009

Medicare rate

$0.00

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

Payment rules and modifiers for J7313

J7313 has no global surgery period, no multiple-procedure, bilateral or assistant-at-surgery adjustment, and no professional/technical split. What changes the payment is where the service happens: the place of service on the claim decides whether Medicare pays the office or the facility rate.

Place of service · J7313

Which rate does Medicare pay?

The POS code on the claim line (CMS-1500 box 24B).

POS 11 · non-facility rate · national

—

J7313 isn’t priced in this setting.

J7313 compared with similar codes

Compare codes · National

4 codes, side by side

Office or facility?

  • J7313

    Iluvien implant, per 0.01 mg0 wRVU

    Not priced

  • J7312

    Dexamethasone implant, per 0.1 mg0 wRVU

    Not priced

  • J7314

    Yutiq implant, per 0.01 mg0 wRVU

    Not priced

  • J7311

    Retisert implant, per 0.01 mg0 wRVU

    Not priced

How to choose

J7312Dexamethasone implantPer 0.1 mg
J7312 identifies a dexamethasone intravitreal implant. J7313 is specific to the Iluvien fluocinolone implant.
J7314Yutiq implantPer 0.01 mg
J7314 identifies Yutiq, another fluocinolone implant product. Use J7313 for Iluvien, not simply because the active drug is the same.
J7311Retisert implantPer 0.01 mg
J7311 identifies the Retisert fluocinolone implant. J7313 is the Iluvien product code; the codes distinguish the implant products.

Codes related to J7313

Related codes aren’t interchangeable: bill the code that matches the service performed.

Codes related to J7313
CodeHow it relatesNational office range
Used instead
J7312Dexamethasone implant, per 0.1 mgDexamethasone intravitreal implant; a different drug implant used for macular edema.No office rate
Same family
J7314Yutiq implant, per 0.01 mgYutiq is another fluocinolone acetonide intravitreal implant, identified under its own product code.No office rate
Often billed with
67028Intravitreal injection, medication delivered into vitreous cavityIntravitreal drug placement procedure code that may accompany reporting of the implant.$103.45–$145.87

J7313 billing questions

What does one unit of J7313 represent?

One unit represents 0.01 mg of fluocinolone acetonide. A 0.19-mg Iluvien implant corresponds to 19 units.

Is J7313 the code for placing the implant?

No. J7313 identifies the drug quantity; CPT 67028 represents the intravitreal placement procedure when reported.

How does J7313 differ from J7312?

J7313 identifies the Iluvien fluocinolone implant. J7312 identifies a dexamethasone intravitreal implant, a different drug product that may be used for macular edema.

How does J7313 differ from J7314?

Both identify fluocinolone intravitreal implants, but J7313 is Iluvien and J7314 is Yutiq. Select the code for the product actually supplied.

How does Medicare classify J7313?

It has physician fee schedule status E and is excluded from that schedule. When covered, it is a Part B drug generally priced using CMS’s quarterly ASP drug files; the Medicare contractor determines coverage.

Where these rates come from

FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.

CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027

Open CMS sourceHow we calculate rates

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