Compounded Drug Fees
Palmetto GBA recently completed a review of the current compounded drug fee allowances. The fees detailed below are in effect for dates of service July 1, 2018, and after. The fees are based on the use of our Redbook drug compendia database using products categorized for compounding. Claims payment will be made based on the following drug allowances plus a $60 compounding fee
HCPCS Code/Modifier
HCPCS Code J7999 – Compounded drug, not otherwise classified.
KD Modifier – Drug or biological infused through DME.
|
Drug Name
|
Strength
|
Current Fee
|
Revised Fee
|
|---|---|---|---|
|
Baclofen
|
Per mcg
|
$0.003
|
$0.001
|
|
Clonidine
|
Per mcg
|
$0.001
|
$0.001
|
|
Fentanyl
|
Per mcg
|
$0.007
|
$0.005
|
|
Hydromorphone
|
Per mg
|
$0.130
|
$0.603
|
|
Morphine Sulfate
|
Per mg
|
$0.050
|
$0.075
|
|
Sufentanyl
|
Per mcg
|
$0.090
|
$0.060
|
|
Prialt
|
Priced based on CMS ASP Fees for date of service.
|
||
Note: The inclusion or exclusion of a fee does not imply Medicare coverage.
In order to avoid resubmissions and appeals and receive the highest payment possible for the compound drugs, please ensure that the total dosage for each drug is indicated/included with the claim.