- Outpatient Services for Registered Inpatients
- Using the IVR to Avoid Eligibility and Entitlement-Related Claim Rejections and RTPs
- Allergen Immunotherapy Preparation (95144-95165)
- Ambulatory Surgical Center Approved HCPCS Codes and Payment Rates
- Annual Wellness Visits ‑ Billing Tips for Physicians
- Billing for FQHC MAO Plan Supplemental Payment (PPS Providers)
- Billing for Services Not Included in the FQHC Benefit
- Attention all OPPS Providers: Provider-Based Department Edits Being Implemented on/after 8/1/2023
- Billing for Drug Wastage: JW and JZ Modifier
- Billing Medicare for a Denial - Condition Code 21
- URGENT: Billing Reminders for OPPS Providers with Multiple Service Locations
- Billing Medicare Part A When VA-Eligible Medicare Beneficiaries Receive Services in Non VA Facilities
- Condition Code G0 Reminder
- CPT Code 15830: Excision, Excess Skin and Subcutaneous Tissue; Abdomen, Infraumbilical Panniculectomy
- Electronically Submitted Claims that Exceed $99,999.99
- ESRD Facilities: Clarification for Providing Dialysis Services to Patients Acute Kidney Injury
- Federally Qualified Health Centers Behavioral Health Claims Job Aid
- Federally Qualified Health Centers Contracting with Medicare Advantage Plans
- Fee-For-Time Compensation Arrangement and Reciprocal Billing Job Aid
- Answers to Common Fee-for-Time Compensation Arrangements Questions
- FQHC and Group Therapy Services Job Aid
- Hospital Acquired Conditions and Present on Admission Resource for Acute Care Hospital Facilities
- Long-Term Care Hospitals: How to Request Adjustments of Claims Paid at the Site Neutral Rate
- Inhalation Treatment CPT 94640 – Billing Errors
- Immunization Roster Billing
- JK: Medicare Paid Hospital Providers Twice for Nonphysician Outpatient Services Provided Shortly Before or During Inpatient IPPS Hospital Stays
- Nonphysician Practitioners Billing for Surgical Procedures
- Professional Services During a Patient Hospice Election
- Professional Services During a Patient Hospice Election
- Proper Billing for Finger and Toe Procedures
- Proper Submission of Fee-For-Time Compensation Arrangements and Reciprocal Billing Arrangements
- Proper Use of Taxonomy Codes
- A/B Rebilling Facts
- Common Reciprocal Billing Questions and Answers
- Reminder for Avoiding Claim Denials for Positron Emission Tomography Scans
- Reminder on Deleting Revenue Code Line(s) in the Fiscal Intermediary Standard System Direct Data Entry System
- Repetitive Outpatient Services for Providers Submitting Institutional Outpatient Claims
- Reporting Multiple Qualifying Visits on the Same Date of Service for FQHC Reimbursement
- Unlisted and Not Otherwise Classified Procedure Codes
- What All Facilities Need to Know About the Long-Term Care Hospital Three-Day or Less Interrupted Stay Policy
- Fiscal Year/Calendar Year Claim Split
- Hospitals Must Correctly Assign Severe Malnutrition Diagnosis Codes to Inpatient Claims
Billing for Drug Wastage: JW and JZ Modifier
Properly billing for drug wastage and associated modifiers helps to prevent claims processing errors and denials while ensuring you receive correct reimbursement.
Providers and suppliers are to care for and administer drugs and biologicals to patients in such a way that they can be used most efficiently and in a clinically appropriate manner.
When a billing provider or supplier must discard the remainder of a single-dose container or single-use package after administering a dose to a patient, Medicare provides payment for the amount of drug or biological discarded as well as the dose administered, up to the amount of the drug or biological as indicated on the vial or package label.
HCPCS Code Billing Unit
You must ensure that units of drugs or biologicals administered to Medicare patients are accurately reported according to the complete HCPCS code descriptor. Prior to submitting Medicare claims for drugs or biologicals, it is important to review the complete long descriptor for all applicable HCPCS codes.
Example: When the HCPCS code long descriptor for a specific drug specifies “per 100 mg” and the quantity administered is 200 mg, then the number of billable units for that HCPCS code is equal to two units.
Caution: Do not bill the units for drugs based on the way the drug is packaged, priced, stored or stocked.
Modifiers JW and JZ
Modifiers JW and JZ are required to be billed when applicable. These modifier requirements apply to separately payable drugs under Part B that are supplied in a single-dose container or single-use package based on FDA-approved labeling.
- JW Modifier (Effective 1/1/2017): “Drug amount discarded/not administered to any patient”.
The JW modifier must be reported on a claim to identify the amount of drug discarded and eligible for payment under the discarded drug policy.
Note: The JW modifier must be reported for the discarded amount from a single-dose container or package.
JW Modifier Billing Example
The HCPCS code long descriptor for a specific drug specifies “per one mg.” However, the single dosage vial for that specific drug HCPCS code contains 50 mg. The prescribed dosage for a patient is 80 mg.; therefore, two vials are prepared. A total of 80 mg is administered to the patient.
Report two claim lines applicable to that drug HCPCS code on the claim:- One line is billed with 80 units
- The second line is billed with 20 units and modifier JW (wastage)
- JZ Modifier (Implemented 7/1/2023): “Zero drug amount discarded/not administered to any patient”
The JZ modifier is required to be reported on a claim that includes drugs from single-dose container or package that are separately payable under Medicare Part B when there are no discarded amounts.
Note: The JZ modifier must be reported when there is no discarded amount of any drug from a single-dose container or package for which the JW modifier would be required if there were discarded amounts.
JZ Modifier Billing Example
The HCPCS code long descriptor for a specific drug specifies “per one (1) mg.” However, the single dosage vial for that specific drug HCPCS code contains 50 mg. The prescribed dosage for a patient is 100 mg.; therefore, two vials are prepared. A total of 100 mg is administered to the patient.
Report one claim line applicable to that drug HCPCS code on the claim:- One line is billed with 100 units and the modifier JZ (denoting no wastage)
JW Modifier Exception
The JW modifier is only applied to the amount of drug or biological that is discarded. An exception applies when the actual dose of the drug or biological administered is less than the billing unit. In these situations, the JW modifier is not billed for the wastage.
- Example: One billing unit of drug JXXXX is equal to ten mg (according to the HCPCS code long description) provided in a single use vial. The dosage ordered and administered to a Medicare patient was seven mg.
Although three mg of the drug JXXXX was not administered and was discarded, do not report the JW modifier on the claim because the smallest billable unit is already being billed. Reporting the JW modifier in this situation is a billing error that may result in overpayment.
In this scenario, report the JZ modifier n the claim to confirm there is no wastage.
JW and JZ modifiers do not apply when the drug is:
- Not separately payable (i.e., packaged OPPS or ASC drugs)
- Administered in the FQHC or RHC setting
- Overfilled amounts
Related Content
- Centers for Medicare & Medicaid Services (CMS) Internet-Only Manual (IOM) Publication 100-04, Medicare Claims Processing Manual, Chapter 17 – Drugs and Biologicals, Section 40 Discarded Drugs and Biologicals
- Medicare Program Discarded Drugs and Biologicals – JW Modifier and JZ Modifier Policy Frequently Asked Questions
- CMS Medicare Program Discarded Drugs and Biologicals – JW Modifier and JZ Modifier Policy HCPCS Codes: JW Modifier and JZ Modifier Policy HCPCS Codes
- Note: CMS updates the list quarterly; check the CMS website for the most current list
- NGS article: Drugs and Biologicals – Coverage and Billing
- CMS Change Request 13056, effective 1/1/2023: New Claims Modifier Requirement for Drugs and Biologicals from a Single-Dose Container or Single-Use Package
- MLN Matters® MM13056, effective 1/1/2023: New JZ Claims Modifier for Certain Medicare Part B Drugs
- CMS Change Request 9603, effective 1/1/2017, Revised: JW Modifier: Drug Amount Discarded/Not Administered to Any Patient
Posted 4/29/2024