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See a sample rate comparisonHCPCS J7316 (Ocriplasmin) 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, ocriplasmin, 0.125 mg
| Key Fact | Detail |
|---|---|
| Service Type | Drugs Administered Other than Oral Method Miscellaneous Drugs |
| Common Place of Service | 11 - Office None 20 - Urgent Care Facility 24 - Ambulatory Surgical Center |
| Complexity Level | Moderate |
| Medicaid Fee Schedule | View Medicaid rates for J7316 |
| WAC Price | Lorem ipsum dolor sit amet consectetur Lorem ipsum dolor sit amet consectetur VisitBuyandBill.com |
National average reimbursement for HCPCS J7316 by major payers:
$501.87
$1,201.56
$1,072.63
$1,109.00
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HCPCS J7316
5 of 25 sample ratesHigher to lower in this preview
Montefiore Medical Center
$3,467.90Published rateSt Johns Hospital Of The Hospital Sisters Of The Third Order Of St F, Medicaid Outpatient Number For 2360 Forms
St Johns Hospital Of The Hospital Sisters Of The Third Order Of St F
$1,257.50Published rateBuchanan General Hospital Inc
$1,185.19Published rateBoise Vamc
$1,185.19Published rateTrinitas Regional Medical Center, Trinitas Hospital Acute Care
Rwj Barnabas Health Inc
$82.79Published rate
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Payer Contract Negotiation
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See a sample payer proposalHCPCS J7316 vs. Other Miscellaneous Drugs Codes
The HCPCS J7316 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 J7316 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 |
|---|---|---|
| J7315-HCPCS | Moderate | Mitomycin, ophthalmic, 0.2 mg |
| J7316-HCPCS | Moderate | Injection, ocriplasmin, 0.125 mg |
| J7318-HCPCS | Low | Hyaluronan or derivative, durolane, for intra-articular injection, 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 J7316. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the J7316 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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