Compounded Drug Fees

Published 02/21/2020

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
Current Fee
Revised Fee
Per mcg
Per mcg
Per mcg
Per mg
Morphine Sulfate
Per mg
Per mcg
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.

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