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J7313

J7313 – Injection, fluocinolone acetonide, intravitreal implant (iluvien), 0.01 · NDC Crosswalk & Billing Units

HCPCS Level II J-code · Medicare Part B drug billing
J-code ● 1 NDC crosswalked per 0.01 MG $516.406/unit ASP+6%

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Compiled from public FDA, CMS, DailyMed, NADAC, and related drug data sources. Editorial policy

📋 J7313 summary

J7313 is a HCPCS Level II J-code used to bill fluocinolone acetonide, intravitreal implant (iluvien), 0.01 mg, billed per 0.01 MG. The number of billing units to report depends on the dose administered and the NDC/package billed — use the calculator below.

Brand names associated with J7313: Iluvien

Code J7313 Billing unit 0.01 MG Payment limit $516.406/unit NDC-Crosswalk 1 Quarter Q3 2026 RxCUI Atlas Trace the drug concept →

⚠ An NDC↔HCPCS crosswalk and a published payment limit do not guarantee payer coverage or payment. Always verify the current payer policy and claim format before billing.

🗂️ Key billing facts

HCPCS codeJ7313
DescriptorInjection, fluocinolone acetonide, intravitreal implant (iluvien), 0.01 mg
Billing unit0.01 MG
Payment limit / unit$516.406
Est. ASP / unit$487.175 est.
Mapped NDCs1
Data periodQ3 2026
Last updated2026-08-20

🧾 Billing & reimbursement HCPCS · CMS · EFF. Q3 2026

📅 Payment limits effective Q3 2026 — from the CMS Medicare Part B Payment Limit File (revised quarterly).
Medicare payment limit / unit
$516.406
Est. ASP / unit
$487.175 est.
Est. after 2% sequester
$506.078
HCPCS dosage
0.01 MG
The CMS payment limit is the Medicare Part B drug allowance (ASP + 6%, statutory). After the 2% federal sequester the effective payment is ≈ ASP + 4.3%; estimated ASP = payment limit ÷ 1.06. Source: CMS Medicare Part B Payment Limit File (quarterly), Q3 2026.
Full HCPCS code details (official CMS record)
Long descriptionInjection, fluocinolone acetonide, intravitreal implant (iluvien), 0.01 mg
CoverageC — Carrier/MAC judgment
Pricing indicator51 — Drug — priced under the ASP methodology
Type of service1 — Medical care
BETOS-2O1E
ASC payment groupYY
Action codeN — No maintenance this year
Effective date2019-10-01
Date added2016-01-01
Source: CMS HCPCS Level II code file (imported via admin).

🧮 Dosing & billing-units calculator HCPCS UNITS

One billing unit of J7313 = 0.01 mg. Enter a regimen to convert dose → billing units and project a full course.
Billing units = dose ÷ HCPCS unit size. Most payers require whole units — round per the payer's policy. “Est. Medicare pay” uses the current payment limit. For single-dose vials, drug discarded after administration may be separately billable with modifier JW (JZ when none is discarded) where allowed. Always verify payer-specific rounding before billing.

🔁 NDCs that bill under J7313 WITH EST. MEDICARE PAY

1 NDC map to J7313. Bill units = how many HCPCS units one package represents. Est. pay / pkg = payment limit ($516.406/unit) × that package's bill units.
NDC (11-digit)DrugLabelerPackageStrength Bill units Est. pay / pkg NADAC / unit StatusSource
68611-0190-02 Iluvien fluocinolone acetonide .19 mg/1 IMPLANT ANI 1 TRAY in 1 CARTON (68611-190-02) / 1 APP... .19 mg/1 19 $9,811.71 — ● Active CMS ASP
NDC→HCPCS mappings come from the CMS ASP NDC-HCPCS crosswalk; additional DME MAC / DMEPOS mappings come from PDAC and are labeled separately. NADAC from CMS (weekly). “Status” reflects the product's marketing / obsolete flag in the NDC directory. Presence or absence here does not determine Medicare coverage. Linked NDCs open the full product page.

📊 Medicare utilization & spend CMS · PART B · 2026 (Q1)

Period
Total Part B spend
$4.02M
Claims
399
Beneficiaries
377
Spend / beneficiary
$10,664.02
Spend / claim
$10,076.03
Trend by period
Where J7313 ranks among Part B drugs · 2026 (Q1) · neighbors ±5
Total spending — #260 of 824
#255 ALIMTA* J9305 $4.17M #256 DYSPORT J0586 $4.16M #257 APLIGRAF Q4101 $4.15M #258 INFED J1750 $4.11M #259 ONPATTRO J0222 $4.09M #260 ILUVIEN J7313 $4.02M #261 AXTLE J9292 $4.01M #262 TRELSTAR J3315 $3.85M #263 RIABNI Q5123 $3.85M #264 FORMOTEROL FUMARATE* J7606 $3.83M #265 FOCINVEZ J1434 $3.77M
Total claims — #475 of 824
#470 ADVATE* J7192 424 #471 DEMEROL* J2175 408 #472 VINBLASTINE SULFATE J9360 407 #473 DAXXIFY J0589 404 #474 ILARIS J0638 399 #475 ILUVIEN J7313 399 #476 COMPLETE SL PER SQ C... Q4270 396 #477 XOFIGO A9606 392 #478 LEUKINE J2820 392 #479 CLADRIBINE J9065 391 #480 FOLIC ACID J1808 386

Full breakdown by period (2)
PeriodTotal spendBeneficiariesClaims$/beneficiary$/claim
2026 (Q1) $4.02M 377 399 $10,664.02 $10,076.03
2025 (Q1-Q4) $11.27M 1,034 1,168 $10,901.72 $9,651.01
Provider-administered (Part B) spend, calculated for the whole HCPCS code (CMS does not publish Medicare spend per individual NDC). Self-administered use is covered under Part D instead. A blank patient count means fewer than 11 people — CMS hides counts that small to protect privacy. Source: CMS Medicare Quarterly Part B Spending by Drug (data.cms.gov), updated quarterly.

📈 Medicare Part B claims detail CMS PSPS · 2024

Calendar-year 2024 Medicare Part B fee-for-service activity for this HCPCS code, summed across all carriers, localities and specialties (CMS Physician/Supplier Procedure Summary). A “service” is one billed line/unit — not one claim — so counts run higher than claim counts.
Allowed charges
$10.58M
Medicare paid
$8.21M
Submitted services
22,956
Denial rate
6.5%
Allowed / service
$493.10
Submitted charges
$19.87M
Source: CMS Physician/Supplier Procedure Summary (PSPS), CY2024 — Medicare Part B carrier + DME fee-for-service claims (excludes Medicare Advantage). Figures are for the whole HCPCS code, which may cover uses beyond this drug. ⚠ CMS hides any figure covering fewer than 11 patients (a privacy rule), so totals — especially denials and low-volume codes — run a little low.

🗺️ Where J7313 is utilized CMS · BY PROVIDER · 2024

Medicare Part B services for this code by the rendering provider's state — 1,787 services across 4 states & territories in 2024 (CMS reports include DC and U.S. territories). Switch to per 100k to compare states fairly regardless of population. Hover or tap a state for its top ZIP codes.
Hover or tap a state to see its numbers + top ZIP codes.
Per-capita = services ÷ 2023 state population × 100,000 (so high-population states aren't automatically "hotter"). Counts reflect the provider's location, not the patient's. Providers with fewer than 11 patients are hidden by CMS for privacy, so totals run low and per-100k can be noisy in small states — read this as relative geography, not exact counts. Source: CMS Medicare Physician & Other Practitioners — by Provider and Service, 2024.

🗃️ Data sources & freshness

Every figure on this page is computed from public datasets. Here's what each section draws on and how current it is.
HCPCS code & descriptor
CMS HCPCS Level II code file
Loaded
Payment limit & billing unit
CMS Medicare Part B ASP Pricing File (quarterly)
Q3 2026 · as of 2026-08-20
NDC ↔ HCPCS crosswalk
CMS ASP NDC-HCPCS crosswalk
1 NDC mapped
NADAC acquisition cost
CMS National Average Drug Acquisition Cost (weekly)
Not available for mapped NDCs
Utilization & spend
CMS Part B Spending by Drug · PSPS · Physician & Other Practitioners
Latest data year 2026
Figures are estimates for reference and may lag the source files. Always verify against the current CMS files and your payer's policy before submitting claims.

⚠️ Practical billing caveats

  • A crosswalk is not coverage. An NDC mapping or a published payment limit does not guarantee a payer will cover or pay this code. Check the specific plan's policy.
  • Units ≠ milligrams. Bill the number of HCPCS units (dose ÷ the code's unit size), not the milligram dose. Use the calculator above.
  • Discarded drug. For single-dose vials, drug discarded after administration may be separately billable with modifier JW (and JZ when nothing is discarded) where the payer allows.
  • Rounding & partial units. Many payers require whole units; round per the payer's policy, not automatically up.
  • The code can cover more than this drug. Some HCPCS codes span multiple products or strengths — confirm the exact code for the product administered.
  • Figures lag. ASP limits change quarterly and utilization data are released with a delay. Verify against the current CMS files before billing.

❓ J7313 billing FAQ

What is HCPCS code J7313?
J7313 is a HCPCS Level II J-code used to bill Injection, fluocinolone acetonide, intravitreal implant (iluvien), 0.01 mg under Medicare Part B and most medical (not pharmacy) benefits.
What is the billing unit for J7313?
One unit of J7313 represents 0.01 MG. Report the number of units equal to the dose administered divided by 0.01 MG.
How many units of J7313 should I bill?
Divide the dose administered by the code's unit size (0.01 MG) to get the number of billing units, then round per your payer's policy. The calculator on this page converts a dose into billing units and projects a full course.
How much does Medicare pay for J7313?
The Medicare Part B payment limit is $516.406 per unit (Q3 2026), based on ASP + 6%. After the 2% sequester the effective payment is about $506.078 per unit. Payment limits are revised quarterly.
Which NDCs bill under J7313?
1 NDC currently map to J7313 in the CMS ASP NDC-HCPCS crosswalk. See the NDC crosswalk table above for each product, package, billing units and estimated reimbursement.
Does a crosswalk mean J7313 is covered?
No. An NDC-to-HCPCS crosswalk and a published payment limit do not guarantee coverage or payment. Coverage depends on the payer, the diagnosis and the site of care — always verify the current policy before billing.
For professional billing reference only — verify against the current CMS files before submitting claims.