Cost analysis for CPT J7999 — Compounded drug, not otherwise classified
Average Medicare Payment
$94.90
2023 data
Total Payments (2023)
$30.0M
Services (2023)
333.6K
Price Change (2016–2023)
+30.8%
| Year | Avg Payment | Total Payments | Services | YoY Change |
|---|---|---|---|---|
| 2016 | $72.57 | $22.6M | 377.9K | — |
| 2017 | $82.49 | $20.4M | 295.5K | +13.7% |
| 2018 | $85.29 | $23.1M | 306.8K | +3.4% |
| 2019 | $106.85 | $27.9M | 311.7K | +25.3% |
| 2020 | $113.99 | $35.4M | 352.9K | +6.7% |
| 2021 | $117.33 | $37.7M | 383.1K | +2.9% |
| 2022 | $103.49 | $33.5M | 365.3K | -11.8% |
| 2023 | $94.90 | $30.0M | 333.6K | -8.3% |
The most expensive state pays 10.1x more than the cheapest for this procedure. NC averages $385.75 vs LA at $38.24.
| State | Avg Payment | Total Payments | Services | Providers |
|---|---|---|---|---|
| NC | $385.75 | $193.3K | 501 | 10 |
| WI | $230.80 | $222.7K | 965 | 11 |
| MN | $211.13 | $508.6K | 2.4K | 24 |
| MI | $168.33 | $68.7K | 408 | 6 |
| MS | $153.87 | $839.3K | 5.5K | 13 |
| MA | $149.15 | $136.2K | 913 | 5 |
| CA | $135.32 | $8.3M | 61.6K | 239 |
| AR | $125.14 | $678.2K | 5.4K | 33 |
| PA | $119.84 | $3.6M | 30.0K | 108 |
| WV | $97.92 | $12.1K | 124 | 1 |
| NY | $93.92 | $175.0K | 1.9K | 13 |
| CT | $91.28 | $29.8K | 327 | 5 |
| AK | $77.69 | $52.4K | 675 | 6 |
| TX | $76.87 | $2.0M | 26.2K | 140 |
| AL | $74.59 | $48.6K | 651 | 1 |
| AZ | $73.20 | $2.2M | 30.1K | 47 |
| WA | $71.98 | $1.1M | 14.8K | 67 |
| HI | $71.97 | $166.2K | 2.3K | 13 |
| OH | $71.57 | $96.6K | 1.3K | 8 |
| IL | $71.40 | $57.2K | 801 | 11 |
| UT | $71.23 | $355.2K | 5.0K | 21 |
| ND | $71.17 | $28.2K | 396 | 3 |
| OR | $71.16 | $1.2M | 17.1K | 52 |
| CO | $70.04 | $968.6K | 13.8K | 45 |
| SD | $70.02 | $430.5K | 6.1K | 11 |
| MD | $69.59 | $402.2K | 5.8K | 45 |
| NJ | $69.09 | $762.1K | 11.0K | 54 |
| OK | $68.88 | $218.0K | 3.2K | 15 |
| MT | $68.47 | $454.4K | 6.6K | 10 |
| TN | $66.58 | $54.9K | 825 | 7 |
| ID | $66.29 | $377.4K | 5.7K | 20 |
| KY | $65.92 | $36.9K | 560 | 3 |
| FL | $65.53 | $3.2M | 48.2K | 193 |
| GU | $65.47 | $8.9K | 136 | 3 |
| NM | $63.79 | $204.9K | 3.2K | 11 |
| VI | $61.52 | $8.6K | 140 | 1 |
| DC | $60.72 | $27.4K | 451 | 3 |
| VA | $58.68 | $72.8K | 1.2K | 21 |
| IA | $58.22 | $22.8K | 391 | 3 |
| PR | $57.96 | $25.6K | 442 | 4 |
| MO | $54.24 | $114.2K | 2.1K | 9 |
| KS | $44.18 | $161.7K | 3.7K | 6 |
| IN | $41.98 | $15.6K | 371 | 4 |
| LA | $38.24 | $380.7K | 10.0K | 23 |
| Provider | Specialty | State | Payments | Services | Avg/Service |
|---|---|---|---|---|---|
| Muhammad Alghannam | Anesthesiology | CA | $2.3M | 599 | $3782.92 |
| Pentec Health Inc | Pharmacy | PA | $2.2M | 9.9K | $224.05 |
| Dale Kiker | Anesthesiology | CA | $1.0M | 367 | $2760.48 |
| Bond Pharmacy Inc | Pharmacy | MS | $632.5K | 2.4K | $263.21 |
| Mehran Taban | Ophthalmology | CA | $295.8K | 4.0K | $73.43 |
| Shann Lin | Ophthalmology | PA | $211.4K | 3.2K | $65.75 |
| Nathan Miller | Pain Management | CA | $205.8K | 307 | $670.33 |
| Shawn Agee | Ophthalmology | FL | $203.9K | 3.1K | $65.78 |
| Peter Schultz | Internal Medicine | MN | $172.1K | 667 | $258.01 |
| John Sullivan | Ophthalmology | FL | $168.2K | 2.6K | $65.85 |
| Stephen Desouza | Ophthalmology | AZ | $167.9K | 2.3K | $73.20 |
| Mikhail Ivanovsky | Pain Management | AR | $161.6K | 160 | $1010.06 |
| Paul Carnes | Pain Management | NC | $158.6K | 44 | $3604.77 |
| Evelyn Fu | Ophthalmology | WA | $140.5K | 1.9K | $73.27 |
| Ravi Panjabi | Anesthesiology | CA | $128.3K | 129 | $994.87 |
| Benjamin Bakall | Ophthalmology | AZ | $126.4K | 1.7K | $73.41 |
| Russ Levitan | Anesthesiology | CA | $125.1K | 287 | $436.01 |
| Derek Kunimoto | Ophthalmology | AZ | $121.3K | 1.7K | $73.18 |
| Elizabeth Atchison | Ophthalmology | SD | $119.4K | 1.7K | $70.55 |
| Jonathan Harder | Ophthalmology | CO | $115.5K | 1.8K | $64.98 |
The data suggests significant pricing inconsistencies for CPT J7999. With a 10.1x price gap between the most and least expensive states, geography plays an outsized role in what Medicare pays for this procedure.
Costs have risen 30.8% since 2016, outpacing inflation and raising questions about whether reimbursement rates reflect actual costs.
This analysis is based on publicly available CMS data and does not account for patient complexity, comorbidities, or facility-specific factors that may justify pricing differences.
Note: All data is from publicly available Medicare records. OpenMedicare is an independent journalism project not affiliated with CMS.