Since 2017, CMS required the use of the JW modifier for reporting discarded amounts of drugs or biologicals administered from a single-dose container or a single-dose package. Medicare Part B provides reimbursement for the discarded amount.
Beginning in 2023, billing providers and suppliers were required to report the JZ modifier on all claims that bill for drugs from single-dose containers – that are separately payable under Medicare Part B – when there is NO “discarded amount.” This article provides a high-level overview of the requirements for using the JW and JZ modifier.
|Drug amount discarded / not administered to any patient
|Discarded drug not administered
|Zero drug amount discarded / not administered to any patient
|Zero drug wasted
When are these modifiers not required?
Physicians and other health care professionals should not report JW and JZ modifiers for amounts of drugs greater than the identified amount on the package or label or drugs from multiple-dose containers; they are prohibited from billing Medicare for overfill. The JW and JZ modifiers are not required for vaccines for influenza, pneumococcal, and COVID–19 vaccines. The JW modifier should not be used when the dose of the drug administered is less than the billing unit.
Recent policies on modifiers
2024: CMS requires that drugs separately payable under Part B – from single-dose containers that are furnished by a supplier who is not administering the drug – must be billed with the JZ modifier. CMS also clarified that Medicare Advantage plans may, but are not required to, adopt the JW/JZ modifier requirement for single-dose drugs.
2023: In 2023, CMS required health care practitioners use the JZ modifier in situations where there is no discarded amounts of a drug from single-use vials or packages that are separately payable under Part B. They must use a JW modifier to identify any discarded amounts. CMS implemented this policy in phases:
- Physicians and other health care professionals must report the JZ modifier on applicable claims as of July 1, 2023.
- Starting October 1, 2023, claims for drugs from single-dose containers that do not properly contain the modifiers may be returned as un-processable.
The Advocacy Council – ADVOCATING FOR ALLERGISTS AND THEIR PATIENTS.