The Record

Use modifiers JW and JZ when billing Part B medical benefit drug claims

To receive timely and appropriate payment of Part B claims for Medicare Plus Blue℠ and BCN Advantage℠ members, health care providers, facilities and suppliers must include the JW or JZ modifier when billing for single-dose vials or other single-use packages of Part B drugs. This doesn’t apply to multiuse vials or other multiuse packages.

For claims submitted on or after Oct. 1, 2023, the Centers for Medicare & Medicaid Services requires health plans to return claims without processing them when claim lines don’t include the appropriate modifiers. The claims must then be resubmitted with the appropriate modifiers. This applies to all providers, facilities and suppliers who buy and bill separately payable single-container drugs under Medicare Part B.

Here's how to use these HCPCS Level II modifiers:

The JW modifier is required when reporting the amount of drug that is discarded and is eligible for payment under the discarded drug policy.

Example: A single-use vial that is labeled to contain 100 units of a drug has 95 units administered to the member and five units discarded. The 95-unit dose is billed on Line 1, while the discarded five units are billed on Line 2 using the JW modifier. Both line items are processed for payment. Providers must record the discarded amounts of drugs and biologicals in the member’s medical record.

The JZ modifier is used to attest that no amount of drug was discarded.

Here’s what you need to include on these claims:

Type of claim

What to do

Waste-related claim (JW modifier)

Submit two complete claim lines. Include the following information.
Line 1:

HCPCS code for the drug administered
Number of units administered to the member (in the example above, you’d enter 95 units)
Calculated price for only the amount administered to the member

Important: Don’t include a modifier on Line 1.
Line 2:

HCPCS code for the drug that was wasted
JW modifier to indicate waste
Number of units wasted (in the example above, you’d enter 5 units)
Calculated price for only the amount of drug wasted

Claim with no waste — Entire amount of drug is administered (JZ modifier)

Submit one claim line. Include the following information:

HCPCS code for the drug administered
JZ modifier to indicate there was no waste
Number of units administered to the member
Calculated price for the amount of drug administered

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*CPT codes, descriptions and two-digit numeric modifiers only are copyright 2023 American Medical Association. All rights reserved.