HCPCS code J7313: Iluvien implant, per 0.01 mg2026 Medicare rate & RVUs in Missouri
Reports fluocinolone acetonide in the Iluvien intravitreal implant, generally used to treat diabetic macular edema, in 0.01-mg units.
CMS doesn’t publish an office rate for J7313 in Missouri.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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On this page 9 sections
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 in Missouri
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
| Payment locality | Office | Facility |
|---|---|---|
| Metropolitan Kansas City, MO | Unavailable | Unavailable |
| Metropolitan St. Louis, MO | Unavailable | Unavailable |
| Rest of Missouri | Unavailable | Unavailable |
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
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
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J7313 isn’t priced in this setting.
J7313 compared with similar codes
Compare codes · National
4 codes, side by side
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.
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
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