Summary & Overview
HCPCS J7311: Fluocinolone Acetonide Intravitreal Implant (Retisert) 0.01 mg
HCPCS Level II code J7311 denotes the intravitreal implant of fluocinolone acetonide (Retisert), 0.01 mg. The code captures delivery of a sustained‑release corticosteroid implant used in chronic posterior segment inflammatory eye disease and related ophthalmic conditions. Nationally, implants such as this are clinically significant because they represent high-cost, procedure‑driven therapies administered in specialized settings and often subject to payer-specific coverage rules.
Key payers addressed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context, typical sites of service, and the types of benchmarks and policy considerations commonly applied to high-cost ophthalmic implants. The publication outlines how this HCPCS Level II code is used for billing intravitreal implant placement and what stakeholders typically review when assessing coverage and reimbursement for such therapies.
The piece provides actionable reference material for revenue cycle and clinical leaders: definitions and coding precision for J7311, expected service settings, and the scope of payer involvement. Data not available in the input for payer-specific rates, utilization benchmarks, taxonomies, ICD‑10 pairings, and related codes are noted as unavailable in source material; readers will learn which elements are routinely required for claims adjudication and policy reviews.
Billing Code Overview
HCPCS Level II code J7311 represents the injection of fluocinolone acetonide intravitreal implant (Retisert), 0.01 mg. This code describes a one-time intravitreal implant procedure delivering a corticosteroid directly into the eye for chronic posterior segment inflammatory conditions.
Service Type: Intravitreal implant administration
Typical Site of Service: Ambulatory surgical center or hospital outpatient department, where ophthalmic implant procedures and retinal surgeries are performed.
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 68-year-old patient with chronic noninfectious posterior uveitis presents to a retina specialist for management of recurrent intraocular inflammation causing progressive macular edema and visual decline. Prior treatment included topical corticosteroids and periocular corticosteroid injections with partial response; systemic immunosuppression was contraindicated due to comorbidities. The retina specialist recommends intravitreal implantation of a sustained-release fluocinolone acetonide device (J7311, 0.01 mg) placed in the operating room or procedure suite under monitored anesthesia care.
Pre-procedure workflow includes informed consent, review of medical and ophthalmic history, medication reconciliation (anticoagulant management if applicable), topical antisepsis, and topical or local anesthesia. The procedure involves sterile implant insertion through a pars plana incision with appropriate intraoperative documentation of laterality, implant lot number, and immediate complications. Post-procedure workflow includes intraocular pressure measurement, topical antibiotics and steroid regimen, follow-up visits to monitor intraocular pressure and efficacy, and documentation of any complications (e.g., elevated intraocular pressure, implant migration, endophthalmitis). Typical sites of service are an ambulatory surgery center or hospital outpatient department; when performed in-office, billing and payer rules vary by payor and state.
Coding Specifications
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