HCPCS code J7999: Compounded drug, no specific HCPCS drug code2026 Medicare rate & RVUs in Massachusetts
Reports a compounded drug without a more specific HCPCS drug code; when Medicare covers it, payment is made under another method rather than the physician fee schedule.
CMS doesn’t publish an office rate for J7999 in Massachusetts.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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On this page 9 sections
What J7999 covers
J7999 identifies a compounded drug for which no more specific HCPCS drug code is used. Compounding combines drug ingredients or changes a preparation to produce the medication furnished to the patient. The billing clinician or facility reports it for a compounded medication furnished in an office or facility setting. It identifies the medication rather than the injection or infusion procedure used to administer it. Claim documentation should identify the actual compounded medication and amount furnished.
CMS assigns J7999 physician fee schedule status E, which excludes it from the physician fee schedule. When Medicare covers the medication, payment is made under another method. For a covered Part B drug, CMS generally prices it using quarterly Average Sales Price drug pricing files. Special Medicare coverage instructions apply to this code.
This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.
Where J7999 pays more and less in Massachusetts
| Payment locality | Office | Facility |
|---|---|---|
| Metropolitan Boston, MA | Unavailable | Unavailable |
| Rest of Massachusetts | Unavailable | Unavailable |
How the J7999 rate is calculated
Each of J7999’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · J7999
RVUs × geographic indexes × conversion factor
Work0.00
0.00 RVUs× 1.000 GPCI
Practice expense0.00
0.00 RVUs× 1.000 GPCI
Malpractice0.00
0.00 RVUs× 1.000 GPCI
Adjusted RVUs
0.0000
Conversion factor
$33.4009
Medicare rate
$0.00
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for J7999
J7999 has no global surgery period, no multiple-procedure, bilateral or assistant-at-surgery adjustment, and no professional/technical split. What changes the payment is where the service happens: the place of service on the claim decides whether Medicare pays the office or the facility rate.
Place of service · J7999
Which rate does Medicare pay?
The POS code on the claim line (CMS-1500 box 24B).
POS 11 · non-facility rate · national
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J7999 isn’t priced in this setting.
J7999 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- J3490Unclassified drugNo drug-specific code
- J7999 identifies a compounded drug without a more specific HCPCS code. J3490 is the unclassified-drug code for a drug not reported as compounded.
- J3590Unclassified biologicNo product-specific code
- J3590 is the unclassified code for a biologic drug. J7999 identifies a compounded drug without a more specific HCPCS drug code.
- J9999Antineoplastic drugNot otherwise classified
- J9999 is the unclassified code for an antineoplastic drug. J7999 identifies a compounded drug without a more specific HCPCS drug code.
J7999 billing questions
When should a claim use J7999 instead of J3490?
Use J7999 for a compounded drug without a more specific HCPCS drug code. J3490 is the unclassified-drug code for a drug not reported as a compounded drug.
What should claim documentation identify?
Identify the actual compounded medication and the amount furnished.
How are units reported for J7999?
J7999 does not specify a dose quantity per unit. The amount represented by a claim unit depends on the applicable billing instructions for the preparation.
How does Medicare treat J7999?
CMS assigns status E, excluding J7999 from the physician fee schedule. When Medicare covers the medication, payment is made under another method; covered Part B drugs are generally priced using quarterly ASP drug pricing files.
Does J7999 include drug administration?
No. J7999 identifies the compounded medication, not the injection or infusion service.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
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