2025 HCPCS code J7999
Compounded drug, not otherwise classified.
Modifiers can be applied. For drugs infused through DME, such as an infusion pump, modifier KD should be appended.
In simple words: This code is used for a custom-made medication mixed specially for a patient when a standard medication isn't suitable. This could be because the patient needs a lower dose, is allergic to an ingredient in the regular medicine, or can't take the medicine in its usual form (pill, liquid, etc.).
This code is used for compounded drugs that are not otherwise classified. A compounded drug is a medication specifically prepared for a patient with unique needs. It may involve combining ingredients, altering dosages, or creating different forms not typically available commercially. This code includes compounded drugs not specifically identified by another HCPCS code.
Example 1: A premature infant requires a specific concentration of a medication not available commercially. The physician orders a compounded version, and the pharmacy prepares the medication to the physician's specifications. The compounded drug is billed using J7999., A patient is allergic to a preservative commonly used in a specific medication. The physician orders a compounded version without the preservative. The specially prepared medication is billed using J7999., A patient with dysphagia (difficulty swallowing) cannot take commercially available pills. The physician prescribes a compounded version of the medication in liquid form. This compounded liquid medication is billed using J7999.
Documentation must include a physician's order for the compounded drug with the specific recipe or formulation. The pharmacy's record of the compounding process should also be documented. All documentation should be maintained in the patient's medical record and available for review. For drugs administered through DME, documentation should support the medical necessity of using DME for administration.
** This code represents only the compounded drug itself, not the administration of the drug. Separate codes may be necessary for the administration depending on the route and method. Always check individual payer guidelines for specific billing requirements and coverage policies for compounded drugs.