Question 1

What is HCPCS code J7311?

Accepted Answer

HCPCS code J7311 is "Inj., retisert, 0.01 mg". Injection, fluocinolone acetonide, intravitreal implant (retisert), 0.01 mg

Question 2

What category is J7311 in?

Accepted Answer

J7311 belongs to HCPCS Category J (Drugs Administered Other Than Oral).

Question 3

When should I use HCPCS code J7311?

Accepted Answer

Use J7311 when billing for inj., retisert, 0.01 mg. HCPCS Level II codes like this are used for items and services not covered by CPT codes, including medical supplies, equipment, drugs administered in clinical settings, and certain healthcare services.

Question 4

Is J7311 covered by Medicare?

Accepted Answer

Coverage for J7311 (Inj., retisert, 0.01 mg) depends on medical necessity and specific Medicare guidelines. Check the applicable Local Coverage Determination (LCD) or National Coverage Determination (NCD) for detailed coverage criteria. Private insurers may have different coverage policies.

Question 5

What documentation is required for J7311?

Accepted Answer

Documentation for J7311 should include: the medical necessity for the item or service, supporting diagnosis codes (ICD-10), prescription or order from the treating physician, and proof that the item meets quality standards. Some items may require additional documentation like a Certificate of Medical Necessity (CMN).