Who is affected by this change?

This affects Indiana Medicaid (IHCP) Ophthalmology providers in IN on Medicaid plans.

When does this change take effect?

This change is effective Oct 1, 2019.

Which billing codes are affected?

The following codes are affected: J7311.

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MedicaidReimbursementMedium impact

BT202410: IHCP announces retroactive update to HCPCS code J7311

Indiana Medicaid (IHCP)·IN · Ophthalmology·Claims & Billing

Effective date

Oct 1, 2019

We identified it

Jun 19, 2026

Days to comply

—

Summary

IHCP (Indiana Medicaid) retroactively updated the maximum fee rate for HCPCS code J7311 (fluocinolone acetonide intravitreal implant/Retisert) to $338.58 per unit, effective back to October 1, 2019. This change corrects a rate issue caused by CMS's retroactive description change for this ophthalmology procedure code.

Action Required

Action needed

Immediately: Billing team should review any previously denied or underpaid claims for HCPCS code J7311 (Retisert injections) with dates of service from October 1, 2019 forward and consider resubmitting to Indiana Medicaid for proper reimbursement at the updated rate of $338.58 per unit. Update fee schedules in billing system to reflect the new maximum rate for future claims.

Affected Billing Codes

J7311

Related policy hubs

Indiana Medicaid (IHCP) policies IN policy changes Ophthalmology Code J7311