How much does Medicare pay for HCPCS J7999?

Medicare allowed an average of $130.30 per service and paid $101.83 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $401.55, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is HCPCS code J7999?

Compounded drug, not otherwise classified. It was billed 267,640 times to 74,327 Medicare beneficiaries by 1,294 providers in 2024.

Which specialty bills J7999 most?

Ophthalmology, with 232,673 services from 1,064 clinicians. Next are Pharmacy, Interventional Pain Management, Anesthesiology.

HCPCS J7999

Compounded drug, not otherwise classified

$130.30Medicare-allowed amount per service, averaged across 267,640 services

Providers submitted

$401.55

Asking price, not received

Medicare allowed

$130.30

The fee schedule figure

Medicare paid

$101.83

Balance is patient coinsurance

Providers submitted an average of $401.55 for this code and Medicare allowed $130.30 — 3.1× less. That gap is normal and means nothing on its own: Medicare pays its fee schedule regardless of what is billed, so the submitted figure describes a hospital chargemaster, not a price anyone paid. Of the allowed amount Medicare paid $101.83 (78%); the rest is the patient’s coinsurance and deductible.

Services: 267,640
Beneficiaries: 74,327
Providers billing it: 1,294
Total allowed: $34,873,492

What Medicare pays for HCPCS J7999

Across 267,640 services billed by 1,294 providers to 74,327 beneficiaries, Medicare allowed an average of $130.30 per service. That is 3.6 services per beneficiary, so this is a code patients typically receive more than once. The allowed amount is the figure that matters: it is what Medicare and the patient together owe, set by the fee schedule and adjusted for local practice costs. What a provider chose to submit has no bearing on it.

Who bills J7999

Specialty	Services	Beneficiaries	Avg allowed	Providers
Ophthalmology	232,673	65,632	$88.23	1,064
Pharmacy	16,664	2,098	$297.41	6
Interventional Pain Management	3,474	1,012	$139.60	34
Anesthesiology	3,170	968	$1802.55	34
Pain Management	2,609	932	$416.86	40
Home Infusion Therapy Services	1,849	475	$311.11	3
Physician Assistant	1,755	906	$201.84	33
Nurse Practitioner	1,391	650	$216.68	26
Physical Medicine and Rehabilitation	1,228	511	$170.53	18
Internal Medicine	833	257	$325.60	1
Family Practice	685	259	$277.35	8
Emergency Medicine	329	54	$306.81	3
Orthopedic Surgery	326	304	$44.63	17
Neurosurgery	271	91	$123.30	3
Hospice and Palliative Care	178	71	$195.40	1

J7999 reimbursement by state

Two different numbers. Allowed is what Medicare actually allowed in that state, which includes the local practice-cost adjustment. Standardized strips that geographic adjustment out of the payment, so it is the column to use when comparing states — a difference there reflects how the code was billed, not what it costs to run a practice locally.

State	Services	Allowed	Standardized pmt	Providers
California	56,064	$202.01	$159.08	242
Florida	35,812	$85.89	$67.02	194
Pennsylvania	32,987	$178.47	$140.48	102
Arizona	23,508	$93.88	$73.15	46
Texas	22,008	$100.85	$78.98	160
Oregon	15,591	$92.00	$71.07	49
Washington	8,363	$91.32	$71.71	53
New Jersey	8,349	$87.00	$68.55	48
Colorado	8,091	$89.92	$69.32	37
South Dakota	5,294	$92.22	$70.73	13
Louisiana	4,975	$149.75	$117.84	22
Idaho	4,691	$92.16	$69.57	17
Arkansas	4,198	$119.76	$93.35	29
Montana	3,905	$92.38	$67.54	13
Missouri	3,566	$55.90	$43.88	17
Maryland	3,223	$87.31	$68.29	37
Kansas	3,116	$55.57	$42.38	5
Utah	2,854	$92.07	$70.53	17
Mississippi	2,537	$220.43	$172.63	11
New Mexico	2,315	$83.71	$64.34	11
Minnesota	2,286	$268.65	$212.74	24
Oklahoma	1,944	$90.92	$69.95	17
Hawaii	1,799	$87.83	$74.16	14
New York	1,725	$135.96	$106.73	15
Massachusetts	956	$271.33	$214.09	5
Ohio	739	$96.39	$75.62	7
Virginia	731	$66.51	$52.72	15
Alaska	709	$102.65	$80.59	5
Wisconsin	708	$264.86	$213.61	10
Tennessee	660	$99.10	$77.65	5
Michigan	454	$192.93	$152.51	7
Kentucky	431	$83.66	$65.74	1
Puerto Rico	397	$74.58	$59.03	4
District of Columbia	350	$96.05	$73.86	4
Illinois	348	$91.42	$70.73	7
Connecticut	326	$130.15	$102.73	5
North Carolina	284	$109.71	$88.61	7
North Dakota	283	$92.33	$68.60	3
Indiana	254	$54.83	$42.20	3
U.S. Virgin Islands	246	$83.39	$62.47	2
West Virginia	228	$184.46	$143.54	2
Iowa	140	$71.79	$53.38	4
Georgia	58	$83.64	$66.64	1
Nevada	53	$91.12	$72.60	2
ZZ	46	$83.73	$62.29	1
Guam	38	$64.45	$52.83	1

Billing this code is not the same as earning it

An allowed amount is revenue to a practice, not income to a clinician. It funds staff, premises, equipment and supplies before anyone is paid. What clinicians actually earn is published separately by the Department of Labor, and what industry pays them is published separately again by CMS — this site carries both.

What doctors are paid →·Look up a clinician →·All procedure codes →

Where this comes from. CMS Medicare Physician & Other Practitioners, by Provider and Service, 2024. It covers fee-for-service Original Medicare Part B only — not Medicare Advantage, not Medicaid, and not commercial insurance, which typically pays more for the same code.

How it is averaged. CMS publishes one average per provider per code. Every figure here is re-weighted by the number of services, so a clinician who billed the code 4,000 times counts 4,000 times more than one who billed it twice. CMS also suppresses any provider-code pair with fewer than 11 beneficiaries, so low-volume practice is missing from these totals by design.