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HCPCS J7999 · Level II · J code

J7999: Compounded drug, not otherwise classified, HCPCS Level II J code

Compiled from CMS files by the QuickIntell RCM Editorial Team · Data effective · Method: reference methodology · Report a data correction

Data currency: HCPCS Level II file: October 2026 (effective October 1, 2026); PFS relative value file: RVU26D, released August 26, 2026 (effective October 1, 2026); NCCI MUE tables: 2026 Q4 (effective October 1, 2026); NCCI PTP edits: v323r0 (2026 Q4) (effective October 1, 2026); OPPS Addendum B: October 2026 (effective October 1, 2026); Medicare Coverage Database LCD export: MCD release October 8, 2026 (effective October 4, 2026). Next CMS release: January 1, 2027 (quarterly update) for the HCPCS Level II file and NCCI MUE tables and NCCI PTP edits and OPPS Addendum B; RVU27A with the CY2027 PFS final rule, effective January 1, 2027 for the PFS relative value file; weekly, every Thursday for the Medicare Coverage Database LCD export.

Key facts for J7999

Medicare payment
no PFS amount
PFS status E
Coverage code
D
special coverage instructions apply
Practitioner MUE
2
MAI 3
OPPS status
SI N
Items and Services packaged into APC rates
NCCI PTP pairs
0
practitioner file
LCDs and articles
2 / 3

TL;DR

HCPCS Level II J7999 reads "Compounded drug, not otherwise classified" in the October 2026 file; it dates from 2016. The physician fee schedule lists J7999 with status E (excluded from the physician fee schedule by regulation), so the PFS carries no national amount for it. CMS caps J7999 at practitioner 2 (MAI 3, Clinical: Data); hospital outpatient 6 (MAI 3, Clinical: Data); DME supplier 0 (MAI 3, Published Contractor Policy) units per day in the 2026 Q4 MUE tables. 2 active LCDs and 3 billing and coding articles list J7999 across 13 states: L33461 (Implantable Infusion Pump), L33794 (External Infusion Pumps), A53008, A55239. OPPS status indicator N: Items and Services packaged into APC rates. HCPCS record: BETOS O1E (other drugs); pricing indicator 51; type of service 1 (medical care). Nearby codes: J7799, J8499, J7298, J7297.

J7999 descriptor and code status

The October 2026 HCPCS Level II file describes J7999 as “Compounded drug, not otherwise classified”. It sits in the J section (drugs administered other than oral method and chemotherapy drugs), listed with the other J codes without an ASP payment limit. Although searches often call it the "J7999 CPT code", J7999 is a HCPCS Level II code maintained by CMS, not an AMA CPT code; both go in the same procedure-code field on the claim.

HCPCS file attributes of J7999
FieldValue
Short descriptorCompounded drug, noc
Added to HCPCS2016-01-01
Last actionN (no maintenance), effective 2016-01-01
Coverage codeD: special coverage instructions apply
Pricing indicator51: drugs
BETOS categoryO1E: other drugs
Type of service1: medical care

Medicare payment for J7999

The physician fee schedule lists J7999 with status E (excluded from the physician fee schedule by regulation), so the PFS carries no national amount for it. The amounts below are national figures from the October 2026 CMS files; the contractor applies the locality, rural or state adjustment and the beneficiary's cost sharing.

Physician fee schedule (RVU26D)

Status E: excluded from the physician fee schedule by regulation. Global period XXX (global surgery concept does not apply); PC/TC indicator 9 (professional/technical concept does not apply).

Hospital outpatient (OPPS Addendum B)

Status indicator N (Items and Services packaged into APC rates), with no separate OPPS payment rate.

Ambulatory surgical center (Addendum BB)

Payment indicator N1 (Packaged service/item; no separate payment made).

Medically Unlikely Edits for J7999

CMS caps J7999 at practitioner 2 (MAI 3, Clinical: Data); hospital outpatient 6 (MAI 3, Clinical: Data); DME supplier 0 (MAI 3, Published Contractor Policy) units per day in the 2026 Q4 MUE tables. The practitioner MUE is a date-of-service clinical edit: units above the limit deny but can be paid on appeal with documentation.

MUE values for J7999 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services23 Date of Service Edit: ClinicalClinical: Data
Facility outpatient hospital63 Date of Service Edit: ClinicalClinical: Data
DME supplier03 Date of Service Edit: ClinicalPublished Contractor Policy

The MUE lookup for J7999 shows every setting next to any other code on the same claim.

NCCI edits and add-on rules

No active practitioner PTP pair lists J7999 in v323r0.

J7999 is neither an add-on code nor a designated primary code in the 2026 Q4 NCCI add-on edit file.

Pair counts show exposure, not the answer for one claim. Check J7999 against a second code to see whether the pair bundles and whether a modifier can separate the services.

Medicare coverage policies for J7999

2 active Local Coverage Determinations and 3 billing and coding articles list J7999. Each applies only in its contractor's jurisdiction, and the article carries the diagnosis codes that support the item or service.

Billing and Coding Articles listing J7999
ArticleTitleContractor(s)Related LCD
A53008Billing and Coding: Intraocular BevacizumabNoridian Healthcare Solutions, LLC—
A55239Billing and Coding: Implantable Infusion Pumps for Chronic PainNoridian Healthcare Solutions, LLC—
A56695Billing and Coding: Implantable Infusion PumpPalmetto GBAL33461

Denials to expect on J7999

CARC 50 · N115

the diagnosis or documentation does not meet the LCD or billing article that lists J7999

CARC 151 · N362

units of J7999 exceed the practitioner MUE of 2 per date of service

CARC 4

the modifier reported is inconsistent with the code

CARC 16

the claim lacks the description, invoice or pricing detail a contractor-priced code needs

Where QuickIntell fits for J7999 claims

QuickCode supports qualified coder review of units, modifiers and NCCI pairs for J7999 before the claim leaves, and QuickRCM carries claim readiness and the denial follow-up when an edit or coverage policy is missed.

See QuickCode for coder reviewSee QuickRCM for denial follow-upBook a meeting

Frequently asked questions: HCPCS J7999

What does HCPCS code J7999 describe?

"Compounded drug, not otherwise classified" (short descriptor "Compounded drug, noc"), in the J section (drugs administered other than oral method and chemotherapy drugs). Added 2016-01-01.

Is J7999 a CPT code?

It is not. J7999 belongs to the J section (drugs administered other than oral method and chemotherapy drugs) of HCPCS Level II, the CMS code set, not to AMA CPT. "J7999 CPT code" searches refer to it.

What does Medicare pay for J7999?

The physician fee schedule lists J7999 with status E (excluded from the physician fee schedule by regulation), so the PFS carries no national amount for it.

How many units of J7999 can be billed per day?

CMS caps J7999 at practitioner 2 (MAI 3, Clinical: Data); hospital outpatient 6 (MAI 3, Clinical: Data); DME supplier 0 (MAI 3, Published Contractor Policy) units per day in the 2026 Q4 MUE tables. For the practitioner MUE (MAI 3), units above 2 deny for the day but can be paid on appeal with documentation; denials arrive as CARC 151.

Does Medicare cover J7999?

Coverage code D (special coverage instructions apply). 2 active LCDs and 3 billing and coding articles list J7999 across 13 states: L33461 (Implantable Infusion Pump), L33794 (External Infusion Pumps), A53008, A55239.

Sources

Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-10. Verify against the primary file before billing or contracting decisions. The reference methodology explains how each figure is computed from these files.

Disclaimer

This page is an operational reference compiled from CMS publications: the HCPCS Level II file, the physician, DMEPOS and clinical laboratory fee schedules, OPPS and ASC addenda, NCCI MUE, PTP and add-on edit tables and the Medicare Coverage Database. Amounts are Medicare national figures before locality and state adjustment; Medicaid and commercial payers set their own. CPT codes are shown as numbers only; CPT descriptors are copyright AMA. Nothing here is legal, clinical or billing advice.

Found a figure that does not match the CMS file? Report a data correction with the CMS file and the value you expected; the request reaches the editorial team through the contact form.