Billing and Coding: Implantable Infusion Pump

Medicare may cover compounded medications used in implanted infusion pumps when the use meets all other criteria for services incident to a physician's service; compounded formulations must be billed using HCPCS J7999-KD. Off-the-shelf (non‑compounded) drugs administered via DME may be billed with drug‑specific HCPCS codes and reimbursed under CMS ASP; Prialt as a single agent is billed with J2278-KD, but if mixed it is treated as a compound (J7999-KD). Billing requirements include submitting J7999-KD on a single claim line with quantity '1', documenting drug names and total doses in Box 19 or electronic comments (or attaching details), appending modifier JW for discarded vial portions, and contractor-determined per mg/mcg pricing plus an allowable pharmacy compounding fee.

"Compounded medications for use in implantable infusion pumps may be covered by Medicare when their use meets all other criteria for services provided incident to a physician's service."