FeeBase
Log inGet started
Menu

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

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

CMS RVU26DEffective Oct 1, 2026One payment locality

CMS doesn’t publish a rate for J7313 in Montana.

Separate payment rules applyOffice (non-facility)
Separate payment rules applyHospital or facility

Check a contract rate as a % of Medicare · J7313 nationwide

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

We’ll open J7313 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Montana
  2. What J7313 covers
  3. Compared with other areas
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Related codes
  8. Rate history
  9. Where it applies
  10. Billing questions
  11. 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.

How Montana compares for J7313

J7313 in Montana vs other payment areas
  1. Montana · this pageUnavailable
  2. Los Angeles, CA · CaliforniaUnavailable
  3. Washington, DC area · District of ColumbiaUnavailable
  4. Miami, FL · FloridaUnavailable
  5. Chicago, IL · IllinoisUnavailable
  6. Manhattan, NY · New YorkUnavailable
  7. Alaska · AlaskaUnavailable

Other areas in Montana first, then benchmark localities. Bars start at $0.

Every other payment area

J7313 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama——
ArkansasArkansas——
ArizonaArizona——
Bakersfield, CACalifornia——
Chico, CACalifornia——
El Centro, CACalifornia——
Fresno, CACalifornia——
Hanford, CACalifornia——

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

See J7313 in every payment locality

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.

Codes related to J7313

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

Codes related to J7313
CodeHow it relatesOffice range, Montana
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.$114.22

How J7313 has changed in Montana

J7313 · Office / nonfacility

Rate unavailable

Effective 2026-10-01

A rate is unavailable in one of these releases, so a change cannot be calculated.

Base rate by release · bars start at $0 · select a bar to compare

One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.

What changed, release by release

  1. January 1, 2016

    RVU16A

    No ratechanged toNo rate

    Held through RVU16B, RVU16C, RVU16D, RVU17A, RVU17B, RVU17C, RVU17D, RVU18AR1, RVU18B, RVU18C, RVU18D, RVU19A, RVU19B, RVU19C, RVU19D, RVU20A, RVU20B, RVU20C, RVU20D, RVU21A, RVU21B, RVU21C, RVU21D, RVU22A, RVU22B, RVU22C, RVU22D, RVU23A, RVU23B, RVU23C, RVU23D, RVU24A, RVU24AR, RVU24B, RVU24C, RVU24D, RVU25A, RVU25B, RVU25C, RVU25D, RVU26A, RVU26B, RVU26C, RVU26D.

  2. January 1, 2013

    RVU13AR

    Earliest loaded release: No rate

    Held through RVU13B, RVU13C, RVU13D, RVU14A, RVU14B, RVU14C, RVU14D, RVU15A, RVU15B, RVU15C, RVU15D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01Separate payment rules applySeparate payment rules applyRVU26D
2026-07-01Separate payment rules applySeparate payment rules applyRVU26C
2026-04-01Separate payment rules applySeparate payment rules applyRVU26B
2026-01-01Separate payment rules applySeparate payment rules applyRVU26A
2025-10-01Separate payment rules applySeparate payment rules applyRVU25D
2025-07-01Separate payment rules applySeparate payment rules applyRVU25C
2025-04-01Separate payment rules applySeparate payment rules applyRVU25B
2025-01-01Separate payment rules applySeparate payment rules applyRVU25A
2024-10-01Separate payment rules applySeparate payment rules applyRVU24D
2024-07-01Separate payment rules applySeparate payment rules applyRVU24C
2024-04-01Separate payment rules applySeparate payment rules applyRVU24B
2024-03-09Separate payment rules applySeparate payment rules applyRVU24AR
2024-01-01Separate payment rules applySeparate payment rules applyRVU24A
2023-10-01Separate payment rules applySeparate payment rules applyRVU23D
2023-07-01Separate payment rules applySeparate payment rules applyRVU23C
2023-04-01Separate payment rules applySeparate payment rules applyRVU23B
2023-01-01Separate payment rules applySeparate payment rules applyRVU23A
2022-10-01Separate payment rules applySeparate payment rules applyRVU22D
2022-07-01Separate payment rules applySeparate payment rules applyRVU22C
2022-04-01Separate payment rules applySeparate payment rules applyRVU22B
2022-01-01Separate payment rules applySeparate payment rules applyRVU22A
2021-10-01Separate payment rules applySeparate payment rules applyRVU21D
2021-07-01Separate payment rules applySeparate payment rules applyRVU21C
2021-04-01Separate payment rules applySeparate payment rules applyRVU21B
2021-01-01Separate payment rules applySeparate payment rules applyRVU21A
2020-10-01Separate payment rules applySeparate payment rules applyRVU20D
2020-07-01Separate payment rules applySeparate payment rules applyRVU20C
2020-04-01Separate payment rules applySeparate payment rules applyRVU20B
2020-01-01Separate payment rules applySeparate payment rules applyRVU20A
2019-10-01Separate payment rules applySeparate payment rules applyRVU19D
2019-07-01Separate payment rules applySeparate payment rules applyRVU19C
2019-04-01Separate payment rules applySeparate payment rules applyRVU19B
2019-01-01Separate payment rules applySeparate payment rules applyRVU19A
2018-10-01Separate payment rules applySeparate payment rules applyRVU18D
2018-07-01Separate payment rules applySeparate payment rules applyRVU18C
2018-04-01Separate payment rules applySeparate payment rules applyRVU18B
2018-01-01Separate payment rules applySeparate payment rules applyRVU18AR1
2017-10-01Separate payment rules applySeparate payment rules applyRVU17D
2017-07-01Separate payment rules applySeparate payment rules applyRVU17C
2017-04-01Separate payment rules applySeparate payment rules applyRVU17B
2017-01-01Separate payment rules applySeparate payment rules applyRVU17A
2016-10-01Separate payment rules applySeparate payment rules applyRVU16D
2016-07-01Separate payment rules applySeparate payment rules applyRVU16C
2016-04-01Separate payment rules applySeparate payment rules applyRVU16B
2016-01-01Separate payment rules applySeparate payment rules applyRVU16A
2015-10-01Not in this releaseNot in this releaseRVU15D
2015-07-01Not in this releaseNot in this releaseRVU15C
2015-04-01Not in this releaseNot in this releaseRVU15B
2015-01-01Not in this releaseNot in this releaseRVU15A
2014-10-01Not in this releaseNot in this releaseRVU14D
2014-07-01Not in this releaseNot in this releaseRVU14C
2014-04-01Not in this releaseNot in this releaseRVU14B
2014-01-01Not in this releaseNot in this releaseRVU14A
2013-10-01Not in this releaseNot in this releaseRVU13D
2013-07-01Not in this releaseNot in this releaseRVU13C
2013-04-01Not in this releaseNot in this releaseRVU13B
2013-01-01Not in this releaseNot in this releaseRVU13AR

Price J7313 for an earlier date of service

Where the Montana rate applies

Montana is a Medicare payment area, not a city. Our Census mapping connects it to 497 cities and communities in Montana. Some span more than one payment area; confirm with the service ZIP.

  • Absarokee
  • Acton
  • Alberton
  • Alder
  • Alzada
  • Amsterdam
  • Anaconda-Deer Lodge County
  • Antelope

Browse all communities in Montana

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

Did this answer your question about what J7313 pays in Montana?

Tell us what you were actually trying to work out. We’ll answer you directly, or build the page that does.

Fee sheets

Put J7313 and the rest of your codes on one sheet

Your codes at your locality, with payer contracts beside Medicare.

Build my fee sheet