HCPCS Level II J7313: Fluocinolone Acetonide (Iluvien) Intravitreal Implant, 0.01 mg

HCPCS Level II code J7313 identifies the intravitreal implant of fluocinolone acetonide (Iluvien) 0.01 mg, a sustained-release corticosteroid device used in ophthalmic care. The code captures a drug-device insertion procedure with implications for specialty ophthalmology billing and outpatient infusion/device supply tables. Nationally, use of intravitreal steroid implants is significant for managing chronic retinal inflammatory and edematous conditions where sustained intraocular corticosteroid delivery can reduce treatment burden.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical purpose of the product, the common site-of-service settings for billing, and the payer landscape addressed in the full publication. The report details reimbursement and coverage benchmarking, common billing and coding considerations for specialty drug-device implants, and relevant policy updates affecting outpatient ophthalmic therapeutics.

The publication is intended to help revenue cycle, coding professionals, and clinical administrators understand coding classification, payer coverage patterns, and operational factors tied to intravitreal implant billing. Data limitations where applicable are noted as "Data not available in the input."

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Billing Code Overview

HCPCS Level II code J7313 represents an intravitreal implant containing fluocinolone acetonide (Iluvien) at a dose of 0.01 mg delivered via injection. This product is an extended-release corticosteroid device intended for intraocular use to provide sustained corticosteroid therapy.

Service type: Intravitreal injection / implant placement

Typical site of service: Ophthalmology clinic, ambulatory surgery center, or hospital outpatient department

Data not available in the input.

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HCPCS Level II J7313: Fluocinolone Acetonide (Iluvien) Intravitreal Implant, 0.01 mg

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Billing Code Overview

Service type: Intravitreal injection / implant placement

Typical site of service: Ophthalmology clinic, ambulatory surgery center, or hospital outpatient department

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A 68-year-old patient with a history of chronic non-infectious posterior uveitis and recurrent macular edema presents to a retina clinic for long-term intravitreal steroid therapy. The retina specialist evaluates the patient in clinic, documents visual acuity, intraocular pressure, anterior and posterior segment exam, and reviews prior treatments including anti-VEGF injections and periocular steroids. After informed consent and verification of indications, the patient is scheduled for an in-office intravitreal placement of a fluocinolone acetonide intravitreal implant (J7313, Iluvien 0.01 mg). The typical workflow includes pre-procedure counseling, topical anesthesia and antisepsis, sterile implant delivery to the vitreous cavity, immediate post-procedure intraocular pressure check, and scheduling of follow-up visits to monitor intraocular pressure and response. The service is most commonly performed in an ophthalmology practice or ambulatory surgical center with staff trained in intravitreal procedures. Billing uses the HCPCS Level II code J7313 for the implant medication; facility and procedural CPT codes and appropriate modifiers are appended per payer requirements.

Coding Specifications

Modifier	Description	When to Use
`00`	No modifier — default billing	Use when no special circumstances apply to the service billing.
`11`	Principal physician — primary surgeon	Use when the reporting physician is the primary surgeon or proceduralist for the implant placement.
`22`	Increased procedural services	Use when additional work beyond the typical service is documented (e.g., complex ocular anatomy requiring extra time).
`50`	Bilateral procedure	Use when both eyes receive the implant during the same operative session and payer accepts bilateral modifier for the associated procedural code (note: `J7313` describes a single implant dose).
`52`	Reduced services	Use when the intended service was partially reduced or not completed as documented.
`53`	Discontinued procedure	Use when the procedure was started but then terminated for patient safety and documentation supports discontinuation.
`78`	Return to OR for related procedure by same physician	Use if a return to the operating room within global period is required for a related intraocular complication.
`80`	Assistant surgeon	Use when an assistant surgeon provided assistance during the procedure and payer requires this modifier.
`62`	Two surgeons	Use when two surgeons with different specialties are required and documented for a single complex procedure.
`JW`	Drug discarded/partially used	Use when portions of a single-use drug/vial are discarded and payer requires reporting of discarded medication.
`JZ`	No drug administered — zero drug unit furnished	Use when billed drug code is reported but no drug was administered (rare for implant billing) and documentation supports this.
`LT`	Left side	Use to identify left eye when laterality reporting is required for associated procedural codes.
`RT`	Right side	Use to identify right eye when laterality reporting is required for associated procedural codes.
`62`	Two surgeons	Use when two surgeons with different specialties are required and documented for a single complex procedure.

Taxonomy Code	Specialty	Notes
207W00000X	Ophthalmology	Retinal specialists and vitreoretinal surgeons commonly perform intravitreal implant procedures.
207W00000X/207VP0000X	Retina/Vitreous Specialist (Vitreoretinal Surgery)	Subspecialists who place intravitreal implants and manage complex posterior segment disease.
207L00000X	Ophthalmic Plastic and Reconstructive Surgery	Occasionally involved for periocular surgical management or complications.
207RP1001X	Optometry (with therapeutics)	May provide pre- and post-procedure follow-up in some practice models; does not perform implant placement.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`H20.9`	Unspecified iridocyclitis	Posterior or chronic intraocular inflammation may prompt long-acting steroid therapy when sight-threatening or recurrent.
`H30.9`	Unspecified chorioretinal inflammation	Inflammatory posterior segment disease with macular edema responsive to intravitreal corticosteroid.
`H35.81`	Nonexudative age-related macular degeneration	May co-exist with macular pathology; steroid implant not first-line but relevant in differential management.
`H35.82`	Exudative age-related macular degeneration	Less commonly treated with steroid implant; included for comprehensive retinal diagnosis mapping.
`H44.9`	Disorder of globe, unspecified	General category for complex ocular disorders where implant therapy may be considered.
`H54.7`	Visual loss, unspecified	Reflects impaired vision severity that can be an outcome measure for implant efficacy.
`H32.9`	Unspecified chorioretinal degeneration	Chronic degenerative conditions leading to edema or inflammation considered when planning therapy.
`E11.321`	Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema	Diabetic macular edema is a common indication for intravitreal steroid implants when other therapies are insufficient.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`67028`	Intravitreal injection of a pharmacologic agent (separate procedure)	Often performed during the same clinic visit for different agents; distinct from long-acting implant placement which may have different procedural reporting requirements.
`67036`	Vitrectomy, pars plana; for removal of vitreous, mechanical (indications vary)	May be performed prior to implant placement in eyes requiring vitrectomy or to manage complications such as vitreous hemorrhage.
`66999`	Unlisted procedure, anterior segment or the eye	Used when no specific CPT code exists for a novel or atypical intravitreal implant procedure and payer requires a procedural code in addition to `J7313` billing.
`99213`	Office or other outpatient visit for the evaluation and management of an established patient, low to moderate complexity	Common for pre-procedure evaluation or routine post-procedure follow-up visits.
`99214`	Office or other outpatient visit for established patient, moderate to high complexity	Used for more complex pre- or post-procedure evaluations (e.g., management of steroid-related IOP elevation).
`92250`	Fundus photography with interpretation and report	May be used for retinal imaging before and after implant placement to document macular edema and response.

Related Codes

HCPCS-J0013-ESKETAMINE-NASAL-SPRAY-1MG

HCPCS Level II J0013: Esketamine Nasal Spray, 1 mg

HCPCS-J0120-INJECTION-TETRACYCLINE-250MG

HCPCS J0120: Injection, Tetracycline, Up to 250 mg

HCPCS-J0121-OMADACYCLINE-INJECTION-1MG

HCPCS J0121: Omadacycline Injection, 1 mg

HCPCS-J0122-ERAVACYCLINE-INJECTION-1MG

HCPCS J0122: Injection, Eravacycline, 1 mg

HCPCS-J0129-ABATACEPT-INJECTION-10MG-PHYSICIAN-SUPERVISED

HCPCS J0129: Abatacept Injection, 10 mg

HCPCS-J0130-INJECTION-ABCIXIMAB-10MG

HCPCS Level II J0130: Injection abciximab, 10 mg

HCPCS-J0131-INJECTION-ACETAMINOPHEN-10MG-PARENTERAL-ANALGESIC

HCPCS J0131: Injection Acetaminophen, 10 mg

HCPCS-J0132-INJECTION-ACETYLCYSTEINE-100MG-INJECTABLE-MEDICATION

HCPCS J0132: Injection, Acetylcysteine 100 mg

HCPCS-J0133-ACYCLOVIR-INJECTION-5MG

HCPCS J0133: Injection, Acyclovir 5 mg

HCPCS-J0134-ACETAMINOPHEN-INJECTION-FRESENIUS-KABI-10MG

HCPCS J0134: Injection, Acetaminophen (Fresenius Kabi), 10 mg

Showing 1–10 of 991

Frequently Asked Questions

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

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Clinical & Coding Specifications

Clinical Context

Coding Specifications

Modifier	Description	When to Use
`00`	No modifier — default billing	Use when no special circumstances apply to the service billing.
`11`	Principal physician — primary surgeon	Use when the reporting physician is the primary surgeon or proceduralist for the implant placement.
`22`	Increased procedural services	Use when additional work beyond the typical service is documented (e.g., complex ocular anatomy requiring extra time).
`50`	Bilateral procedure	Use when both eyes receive the implant during the same operative session and payer accepts bilateral modifier for the associated procedural code (note: `J7313` describes a single implant dose).
`52`	Reduced services	Use when the intended service was partially reduced or not completed as documented.
`53`	Discontinued procedure	Use when the procedure was started but then terminated for patient safety and documentation supports discontinuation.
`78`	Return to OR for related procedure by same physician	Use if a return to the operating room within global period is required for a related intraocular complication.
`80`	Assistant surgeon	Use when an assistant surgeon provided assistance during the procedure and payer requires this modifier.
`62`	Two surgeons	Use when two surgeons with different specialties are required and documented for a single complex procedure.
`JW`	Drug discarded/partially used	Use when portions of a single-use drug/vial are discarded and payer requires reporting of discarded medication.
`JZ`	No drug administered — zero drug unit furnished	Use when billed drug code is reported but no drug was administered (rare for implant billing) and documentation supports this.
`LT`	Left side	Use to identify left eye when laterality reporting is required for associated procedural codes.
`RT`	Right side	Use to identify right eye when laterality reporting is required for associated procedural codes.
`62`	Two surgeons	Use when two surgeons with different specialties are required and documented for a single complex procedure.

Taxonomy Code	Specialty	Notes
207W00000X	Ophthalmology	Retinal specialists and vitreoretinal surgeons commonly perform intravitreal implant procedures.
207W00000X/207VP0000X	Retina/Vitreous Specialist (Vitreoretinal Surgery)	Subspecialists who place intravitreal implants and manage complex posterior segment disease.
207L00000X	Ophthalmic Plastic and Reconstructive Surgery	Occasionally involved for periocular surgical management or complications.
207RP1001X	Optometry (with therapeutics)	May provide pre- and post-procedure follow-up in some practice models; does not perform implant placement.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`H20.9`	Unspecified iridocyclitis	Posterior or chronic intraocular inflammation may prompt long-acting steroid therapy when sight-threatening or recurrent.
`H30.9`	Unspecified chorioretinal inflammation	Inflammatory posterior segment disease with macular edema responsive to intravitreal corticosteroid.
`H35.81`	Nonexudative age-related macular degeneration	May co-exist with macular pathology; steroid implant not first-line but relevant in differential management.
`H35.82`	Exudative age-related macular degeneration	Less commonly treated with steroid implant; included for comprehensive retinal diagnosis mapping.
`H44.9`	Disorder of globe, unspecified	General category for complex ocular disorders where implant therapy may be considered.
`H54.7`	Visual loss, unspecified	Reflects impaired vision severity that can be an outcome measure for implant efficacy.
`H32.9`	Unspecified chorioretinal degeneration	Chronic degenerative conditions leading to edema or inflammation considered when planning therapy.
`E11.321`	Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema	Diabetic macular edema is a common indication for intravitreal steroid implants when other therapies are insufficient.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`67028`	Intravitreal injection of a pharmacologic agent (separate procedure)	Often performed during the same clinic visit for different agents; distinct from long-acting implant placement which may have different procedural reporting requirements.
`67036`	Vitrectomy, pars plana; for removal of vitreous, mechanical (indications vary)	May be performed prior to implant placement in eyes requiring vitrectomy or to manage complications such as vitreous hemorrhage.
`66999`	Unlisted procedure, anterior segment or the eye	Used when no specific CPT code exists for a novel or atypical intravitreal implant procedure and payer requires a procedural code in addition to `J7313` billing.
`99213`	Office or other outpatient visit for the evaluation and management of an established patient, low to moderate complexity	Common for pre-procedure evaluation or routine post-procedure follow-up visits.
`99214`	Office or other outpatient visit for established patient, moderate to high complexity	Used for more complex pre- or post-procedure evaluations (e.g., management of steroid-related IOP elevation).
`92250`	Fundus photography with interpretation and report	May be used for retinal imaging before and after implant placement to document macular edema and response.

Related Codes

HCPCS-J0013-ESKETAMINE-NASAL-SPRAY-1MG

HCPCS Level II J0013: Esketamine Nasal Spray, 1 mg

HCPCS-J0120-INJECTION-TETRACYCLINE-250MG

HCPCS J0120: Injection, Tetracycline, Up to 250 mg

HCPCS-J0121-OMADACYCLINE-INJECTION-1MG

HCPCS J0121: Omadacycline Injection, 1 mg

HCPCS-J0122-ERAVACYCLINE-INJECTION-1MG

HCPCS J0122: Injection, Eravacycline, 1 mg

HCPCS-J0129-ABATACEPT-INJECTION-10MG-PHYSICIAN-SUPERVISED

HCPCS J0129: Abatacept Injection, 10 mg

HCPCS-J0130-INJECTION-ABCIXIMAB-10MG

HCPCS Level II J0130: Injection abciximab, 10 mg

HCPCS-J0131-INJECTION-ACETAMINOPHEN-10MG-PARENTERAL-ANALGESIC

HCPCS J0131: Injection Acetaminophen, 10 mg

HCPCS-J0132-INJECTION-ACETYLCYSTEINE-100MG-INJECTABLE-MEDICATION

HCPCS J0132: Injection, Acetylcysteine 100 mg

HCPCS-J0133-ACYCLOVIR-INJECTION-5MG

HCPCS J0133: Injection, Acyclovir 5 mg

HCPCS-J0134-ACETAMINOPHEN-INJECTION-FRESENIUS-KABI-10MG

HCPCS J0134: Injection, Acetaminophen (Fresenius Kabi), 10 mg

Showing 1–10 of 991

Frequently Asked Questions

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

HCPCS Level II J7313: Fluocinolone Acetonide (Iluvien) Intravitreal Implant, 0.01 mg

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Billing Code Overview

HCPCS Level II J7313: Fluocinolone Acetonide (Iluvien) Intravitreal Implant, 0.01 mg

Sign up for hcpcs J7313 policy alerts

Billing Code Overview

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

What does HCPCS code J7313 represent?

How is J7313 typically billed and where is the service performed?

What clinical indications and follow-up are associated with the implant billed under J7313?

Which modifiers are commonly referenced alongside J7313 billing?

What related CPT and E/M codes should coding professionals consider when billing for J7313?

References

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

What does HCPCS code J7313 represent?

How is J7313 typically billed and where is the service performed?

What clinical indications and follow-up are associated with the implant billed under J7313?

Which modifiers are commonly referenced alongside J7313 billing?

What related CPT and E/M codes should coding professionals consider when billing for J7313?

References