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See a sample rate comparisonHCPCS J7311 (Retisert) Fee Schedule
Last Verified: October 2026
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
Injection, fluocinolone acetonide, intravitreal implant (retisert), 0.01 mg
| Key Fact | Detail |
|---|---|
| Service Type | Drugs Administered Other than Oral Method Miscellaneous Drugs |
| Common Place of Service | None 11 - Office 24 - Ambulatory Surgical Center |
| Complexity Level | Moderate |
| Medicaid Fee Schedule | View Medicaid rates for J7311 |
| Medicare Payment Limit | $340.313  |
| WAC Price | Lorem ipsum dolor sit amet consectetur Lorem ipsum dolor sit amet consectetur VisitBuyandBill.com |
National average reimbursement for HCPCS J7311 by major payers:
$956.72
$459.94
$953.50
$712.73
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HCPCS J7311
5 of 25 sample ratesHigher to lower in this preview
Rosalyn Gamboa
Memorial Cardiopulmonary Group
$961.03Published rateMercy Hospital Of Buffalo
$353.48Published rateFroedtert Health Neighborhood Hospital, LLC, Froedtert Community Hospital
Froedtert Memorial Lutheran Hospital Inc
$333.48Published rateSavoy Medical Management Group, Inc., Savoy Medical Center Hospital Based Physicians
Savoy Medical Management Group Inc
$333.23Published rateCentral Iowa Hospital Corporation, Iowa Methodist Medical Center
M M Anesthesia LLC
$133.28Published rate
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Payer Contract Negotiation
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See a sample payer proposalHCPCS J7311 vs. Other Miscellaneous Drugs Codes
The HCPCS J7311 code is part of the Drugs Administered Other than Oral Method services used for Miscellaneous Drugs. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The HCPCS J7311 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| J7311-HCPCS | Moderate | Injection, fluocinolone acetonide, intravitreal implant (retisert), 0.01 mg |
| J7312-HCPCS | Low | Injection, dexamethasone, intravitreal implant, 0.1 mg |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS J7311. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the J7311 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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