J7316 — Injection, ocriplasmin, 0.125 mg
J7316 is a HCPCS Level II code for injection, ocriplasmin, 0.125 mg. It belongs to the Drugs Administered Other Than Oral Method section. Whether Medicare pays it depends on the coverage rule below.
Medicare coverage: Carrier judgment
Coverage is decided by your Medicare contractor, not by national policy. Whether this is paid depends on the LCD for your jurisdiction and on what the documentation supports.
From the coverage field of the CMS Alpha-Numeric HCPCS File, release 2026Q3-Jul. This states Medicare’s position on the code, not on your particular claim.
Physician fee schedule statusE
Excluded from the physician fee schedule by regulation. Payment, where it exists, comes from another fee schedule (drugs via ASP, supplies via DMEPOS, and so on).
Global period: XXX
Want the dollar amount for your locality? The fee calculator applies your GPCI and the current conversion factor.
Medically Unlikely Edits — units per day
The most units of J7316 Medicare will pay on one date of service. Bill more on a single line and it is denied. The limit is not the same in every setting, so the row that matters is the one matching the claim you are building.
- practitioner
- 3 units MAI 3 — Date of Service Edit: Clinical · CMS Policy
- outpatient
- 3 units MAI 3 — Date of Service Edit: Clinical · CMS Policy
The adjudication indicator decides whether exceeding the limit is worth appealing at all: MAI 1 is a line edit you can support with documentation, MAI 3 is a date-of-service edit that is also appealable, and MAI 2 is absolute — no documentation overrides it. CMS MUE 2026Q3.
The CMS record for J7316
- Long descriptor
- Injection, ocriplasmin, 0.125 mg
- Short descriptor
- Inj, ocriplasmin, 0.125 mg
- Added
- January 1, 2014
- BETOS
- O1E
- Pricing indicator
- 51 — Other
The official wording. This is what the code means.
CMS's 28-character form, which is what shows up on a remittance advice.
When CMS introduced the code.
Berenson-Eggers Type of Service — CMS's own analytic grouping.
Drugs.
Codes adjacent to J7316
HCPCS has no hierarchy — related items simply sit next to each other in the numbering. If J7316 is not quite right, the correct code is very often within a few positions of it.
- J7308Aminolevulinic acid hcl for topical administration, 20%, single unit dosage form (354 mg)
- J7309Methyl aminolevulinate (mal) for topical administration, 16.8%, 1 gramterminated
- J7310Ganciclovir, 4.5 mg, long-acting implantterminated
- J7311Injection, fluocinolone acetonide, intravitreal implant (retisert), 0.01 mg
- J7312Injection, dexamethasone, intravitreal implant, 0.1 mg
- J7313Injection, fluocinolone acetonide, intravitreal implant (iluvien), 0.01 mg
- J7314Injection, fluocinolone acetonide, intravitreal implant (yutiq), 0.01 mg
- J7315Mitomycin, ophthalmic, 0.2 mg
- J7318Hyaluronan or derivative, durolane, for intra-articular injection, 1 mg
- J7320Hyaluronan or derivitive, genvisc 850, for intra-articular injection, 1 mg
- J7321Hyaluronan or derivative, hyalgan, supartz or visco-3, for intra-articular injection, per dose
- J7322Hyaluronan or derivative, hymovis or hymovis one, for intra-articular injection, 1 mg
- J7323Hyaluronan or derivative, euflexxa, for intra-articular injection, per dose
- J7324Hyaluronan or derivative, orthovisc, for intra-articular injection, per dose
- J7325Hyaluronan or derivative, synvisc or synvisc-one, for intra-articular injection, 1 mg
- J7326Hyaluronan or derivative, gel-one, for intra-articular injection, per dose
Questions about J7316
What is HCPCS code J7316?
J7316 is a HCPCS Level II code for injection, ocriplasmin, 0.125 mg. It sits in the Drugs Administered Other Than Oral Method section.
Does Medicare cover J7316?
The CMS HCPCS file marks J7316 as "Carrier judgment". Coverage is decided by your Medicare contractor, not by national policy. Whether this is paid depends on the LCD for your jurisdiction and on what the documentation supports.
How is J7316 paid under the physician fee schedule?
J7316 carries PFS status code E. Excluded from the physician fee schedule by regulation. Payment, where it exists, comes from another fee schedule (drugs via ASP, supplies via DMEPOS, and so on).