J7999 HCPCS code: Compounded drug, not otherwise classified
J7999 is the HCPCS Level II code for compounded drug, not otherwise classified. In 2024 Medicare paid an average of $101.00 per service for J7999 across 280,971 services. Its Medicare coverage code is D (Special coverage instructions apply): Medicare covers it when its national or local coverage criteria are met. The NCCI unit limit is 6 per day on outpatient hospital claims. Medicare volume fell 25% from 2022 to 2024 (375,534 to 280,971 services). In 2024, about 2,634 clinicians billed Medicare for J7999 for 70,340 beneficiaries; California, Florida, Pennsylvania accounted for 46% of services.
Code details
| Field | Value |
|---|---|
| Section | J codes — Drugs administered other than oral method |
| Coverage code | D — Special coverage instructions apply |
| Pricing indicator | 51 — Drug or biological (priced per ASP/average sales price rules) |
| BETOS category | O1E — Other drugs |
| Added | 2016-01-01 |
| Last action effective | 2016-01-01 |
Who bills J7999 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 2,634 |
| Medicare beneficiaries | 70,340 |
| States with claims | 47 |
| Share of services in top 3 states (California, Florida, Pennsylvania) | 46% |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for J7999, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 375,534 | 89,586 | $117.01 | $91.69 |
| 2023 | 345,025 | 84,564 | $116.13 | $90.71 |
| 2024 | 280,971 | 70,340 | $129.26 | $101.00 |
States with the most J7999 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| California | 58,768 | $155.42 |
| Florida | 37,084 | $68.97 |
| Pennsylvania | 33,504 | $139.33 |
| Arizona | 23,604 | $73.14 |
| Texas | 23,544 | $77.71 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 6 | Clinical: Data |
| practitioner claims | 2 | Clinical: Data |
Medicare policy articles for this code
- A52466: Nebulizers - Policy Article (CGS Administrators, LLC (DME MAC) Noridian Healthcare Solutions, LLC (DME MAC)) — mentions this code in its coding guidance
- A52507: External Infusion Pumps - Policy Article (CGS Administrators, LLC (DME MAC) Noridian Healthcare Solutions, LLC (DME MAC)) — mentions this code in its coding guidance
- A53008: Billing and Coding: Intraocular Bevacizumab (Noridian Healthcare Solutions, LLC (MAC - Part A, MAC - Part B))
- A55239: Billing and Coding: Implantable Infusion Pumps for Chronic Pain (Noridian Healthcare Solutions, LLC (MAC - Part A, MAC - Part B))
- A56695: Billing and Coding: Implantable Infusion Pump (Palmetto GBA (MAC - Part B))
- A56695: Billing and Coding: Implantable Infusion Pump (Palmetto GBA (MAC - Part B))
Covered diagnoses (2,828 ICD-10-CM codes)
The diagnoses most often listed as covered in the policy articles above:
| ICD-10-CM | Diagnosis | Articles listing it |
|---|---|---|
| C91.00 | Acute lymphoblastic leukemia not having achieved remission | 2 |
| C91.01 | Acute lymphoblastic leukemia, in remission | 2 |
| C91.02 | Acute lymphoblastic leukemia, in relapse | 2 |
| E08.311 | Diabetes mellitus due to underlying condition with unspecified diabetic retinopathy with macular edema | 2 |
| E08.319 | Diabetes mellitus due to underlying condition with unspecified diabetic retinopathy without macular edema | 2 |
| E08.3211 | Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy with macular edema, right eye | 2 |
| E08.3212 | Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy with macular edema, left eye | 2 |
| E08.3213 | Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy with macular edema, bilateral | 2 |
| E08.3291 | Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy without macular edema, right eye | 2 |
| E08.3292 | Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy without macular edema, left eye | 2 |
Showing 10 of 2,828. The full list, non-covered diagnoses and CSV export are in Caduvo.
What changed for J7999
- 2016-01-01: J7999 added to HCPCS Level II
- Next scheduled CMS quarterly update (HCPCS and DMEPOS fee schedule): 2027-01-01
Frequently asked questions
What is HCPCS code J7999?
J7999 is the HCPCS Level II code for compounded drug, not otherwise classified. Short descriptor: "Compounded drug, noc".
How much does Medicare pay for J7999?
In 2024, the average Medicare payment was $101.00 per service (average allowed $129.26).
Does Medicare cover J7999?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
Which diagnoses support coverage for J7999?
Medicare policy articles that cite J7999 list 2,828 covered ICD-10-CM diagnosis codes across 6 articles. The most cited include C91.00 (Acute lymphoblastic leukemia not having achieved remission), C91.01 (Acute lymphoblastic leukemia, in remission), C91.02 (Acute lymphoblastic leukemia, in relapse). A listed diagnosis is necessary but not sufficient; the policy's other criteria still apply.
How many units of J7999 can be billed per day?
6 on outpatient hospital claims; 2 on practitioner claims (NCCI medically unlikely edits).
Building a device that would bill under a code like this? Caduvo matches a device description to HCPCS/CPT codes, Medicare coverage and payment, and the FDA pathway in one report.
Next steps
- Run a reimbursement report for a device billed under J7999
- Watch J7999 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J7999
Sources: CMS HCPCS Level II release October 2025; CMS DMEPOS fee schedule; CMS NCCI MUE tables; CMS Medicare utilization (physician and DME supplier files); CMS Medicare Coverage Database articles. Fees are Medicare allowables, not commercial rates. Not billing or legal advice.