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See a sample rate comparisonHCPCS J7351 (Durysta) Fee Schedule
Last Verified: September 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, bimatoprost, intracameral implant, 1 microgram
| Key Fact | Detail |
|---|---|
| Service Type | Drugs Administered Other than Oral Method Miscellaneous Drugs |
| Common Place of Service | 11 - Office 24 - Ambulatory Surgical Center None |
| Complexity Level | Moderate |
| Medicaid Fee Schedule | View Medicaid rates for J7351 |
| Medicare Payment Limit | $213.841  |
| WAC Price | Lorem ipsum dolor sit amet consectetur Lorem ipsum dolor sit amet consectetur VisitBuyandBill.com |
National average reimbursement for HCPCS J7351 by major payers:
$207.56
$214.16
$229.42
$223.55
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HCPCS J7351
5 of 25 sample ratesHigher to lower in this preview
Allina Health System, Abbott Northwestern Hospital
Allina Health System
$481.47Published rateMeng Qian
New York University
$222.44Published rateIasis Glenwood Regional Medical Center Lp
$209.88Published rateTexas Spine And Joint Hospital, LLC, Baylor Scott & White Tx Spine & Joint Hos Sur Ctr
Texas Spine And Joint Hospital
$209.88Published rateWajeeha Saeed
New York City Health And Hospitals Corporation
$164.55Published rate
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See a sample payer proposalHCPCS J7351 vs. Other Miscellaneous Drugs Codes
The HCPCS J7351 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 J7351 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 |
|---|---|---|
| J7345-HCPCS | Low | Aminolevulinic acid hcl for topical administration, 10% gel, 10 mg |
| J7351-HCPCS | Moderate | Injection, bimatoprost, intracameral implant, 1 microgram |
| J7352-HCPCS | High | Afamelanotide implant, 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 J7351. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the J7351 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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