J7311 — Injection, fluocinolone acetonide, intravitreal implant (retisert), 0.01 mg
J7311 is a HCPCS Level II code for injection, fluocinolone acetonide, intravitreal implant (retisert), 0.01 mg. It belongs to the Drugs Administered Other Than Oral Method section. Whether Medicare pays it depends on the coverage rule below.
Medicare coverage: Carrier judgment
Coverage is decided by your Medicare contractor, not by national policy. Whether this is paid depends on the LCD for your jurisdiction and on what the documentation supports.
From the coverage field of the CMS Alpha-Numeric HCPCS File, release 2026Q3-Jul. This states Medicare’s position on the code, not on your particular claim.
Physician fee schedule statusE
Excluded from the physician fee schedule by regulation. Payment, where it exists, comes from another fee schedule (drugs via ASP, supplies via DMEPOS, and so on).
Global period: XXX
Want the dollar amount for your locality? The fee calculator applies your GPCI and the current conversion factor.
Medically Unlikely Edits — units per day
The most units of J7311 Medicare will pay on one date of service. Bill more on a single line and it is denied. The limit is not the same in every setting, so the row that matters is the one matching the claim you are building.
- practitioner
- 118 units MAI 2 — Date of Service Edit: Policy · Anatomic Consideration
- outpatient
- 118 units MAI 2 — Date of Service Edit: Policy · Anatomic Consideration
The adjudication indicator decides whether exceeding the limit is worth appealing at all: MAI 1 is a line edit you can support with documentation, MAI 3 is a date-of-service edit that is also appealable, and MAI 2 is absolute — no documentation overrides it. CMS MUE 2026Q3.
The CMS record for J7311
- Long descriptor
- Injection, fluocinolone acetonide, intravitreal implant (retisert), 0.01 mg
- Short descriptor
- Inj., retisert, 0.01 mg
- Added
- January 1, 2007
- BETOS
- O1E
- Pricing indicator
- 51 — Other
The official wording. This is what the code means.
CMS's 28-character form, which is what shows up on a remittance advice.
When CMS introduced the code.
Berenson-Eggers Type of Service — CMS's own analytic grouping.
Drugs.
Codes adjacent to J7311
HCPCS has no hierarchy — related items simply sit next to each other in the numbering. If J7311 is not quite right, the correct code is very often within a few positions of it.
- J7302Levonorgestrel-releasing intrauterine contraceptive system, 52 mgterminated
- J7303Contraceptive supply, hormone containing vaginal ring, eachterminated
- J7304Contraceptive supply, hormone containing patch, each
- J7306Levonorgestrel (contraceptive) implant system, including implants and supplies
- J7307Etonogestrel (contraceptive) implant system, including implant and supplies
- J7308Aminolevulinic acid hcl for topical administration, 20%, single unit dosage form (354 mg)
- J7309Methyl aminolevulinate (mal) for topical administration, 16.8%, 1 gramterminated
- J7310Ganciclovir, 4.5 mg, long-acting implantterminated
- J7312Injection, dexamethasone, intravitreal implant, 0.1 mg
- J7313Injection, fluocinolone acetonide, intravitreal implant (iluvien), 0.01 mg
- J7314Injection, fluocinolone acetonide, intravitreal implant (yutiq), 0.01 mg
- J7315Mitomycin, ophthalmic, 0.2 mg
- J7316Injection, ocriplasmin, 0.125 mg
- J7318Hyaluronan or derivative, durolane, for intra-articular injection, 1 mg
- J7320Hyaluronan or derivitive, genvisc 850, for intra-articular injection, 1 mg
- J7321Hyaluronan or derivative, hyalgan, supartz or visco-3, for intra-articular injection, per dose
Questions about J7311
What is HCPCS code J7311?
J7311 is a HCPCS Level II code for injection, fluocinolone acetonide, intravitreal implant (retisert), 0.01 mg. It sits in the Drugs Administered Other Than Oral Method section.
Does Medicare cover J7311?
The CMS HCPCS file marks J7311 as "Carrier judgment". Coverage is decided by your Medicare contractor, not by national policy. Whether this is paid depends on the LCD for your jurisdiction and on what the documentation supports.
How is J7311 paid under the physician fee schedule?
J7311 carries PFS status code E. Excluded from the physician fee schedule by regulation. Payment, where it exists, comes from another fee schedule (drugs via ASP, supplies via DMEPOS, and so on).