Drugs and Biologicals

Discarded Drugs/Wastage and JW, JZ Modifier

Medicare may pay for discarded drugs or wasted drugs and biologicals when:

  • The provider/supplier must discard the remainder of a single-dose container after administering a dose or quantity to a Medicare patient.
    • Payment for waste from multiple-dose containers is not payable under Medicare. Providers/suppliers should have the most appropriate sized drug container on hand to minimize the amount of discarded drugs.
  • The amount of discard/waste is documented in the medical record
  • Radiopharmaceuticals and imaging agents are excluded from the requirement to use JW/JZ modifiers
  • Skin substitutes are excluded from the requirement to use the JZ modifier and will cause rejections when appended.
    • Only the JW modifier should be used to report drug wastage for skin substitutes.

JW Modifier

Effective 1/1/2017, providers and suppliers are required to report the JW modifier as a way to identify, and be paid for, unused drugs and biologicals.

The basic guidelines for the modifier are:

  • The JW modifier is applicable for claims with unused drugs or biologicals from single-dose containers that are appropriately discarded (except for provided dosages that are under the CAP for Part B drugs and biologicals);
  • The JW modifier is applied to the amount of drug or biological that is discarded, and it is billed on a separate line item; and
  • The discarded drug/biological must be documented in the patient’s medical record.

When billing for waste, ensure the following details are present on the claim:

  • A line item identifying the amount administered of the drug HCPCS code.
  • A separate line identifying the amount of waste for that same drug HCPCS code with the JW modifier appended.
    • Do not bill on a separate line if the actual dose of the drug is less than the billing unit, since payment for the discard is included in the billing unit.
    • When using a NOC code (J3490, J3590, or J9999) to identify a drug that does not have its own HCPCS code, bill the appropriate NOC code with one unit.
    • The name of the drug, does administered and invoice price, must be entered into the comments section (Item 19) of the claim or the electronic claim equivalent.

Reporting Modifier JW

1500 Claim Field ANSI 837 v5010 Loop and Segment Information Required
19 2300 or 2400, NTE02

May also use 2400, SV101-7		 NDC, invoice cost, dosage
24D (line 1) 2400, SV101-2 Drug HCPCS code
24D (line 2) 2400, SV101-2 The same drug HCPCS code
24D (line 2) 2400, SV101-3 JW Modifier
24D (line 3) 2400, SV101-2 Drug administration code
24G 2400, SV104 Units of service are calculated according to the applicable HCPCS code based on dosage

 

JZ Modifier

The 2023 MPFS Final Rule introduced the JZ modifier for Medicare Part B drug claims.

For claims submitted 7/1/2023 and forward, providers shall use modifier JZ to identify zero drug waste from a single-dose container.

Beginning with claims received on 10/1/2023, claims for drugs from single-dose containers that do not use the modifiers in the correct manner may be RTP.

Reference CMS’ Discarded Drugs and Biologicals – JW Modifier and JZ Modifier Policy Frequently Asked Questions for answers to common questions.

Reporting Modifier JZ

1500 Claim Field ANSI 837 v5010 Loop and Segment Information Required
19 2300 or 2400, NTE02

May also use 2400, SV101-7		 NDC, invoice cost, dosage
24D (line 1) 2400, SV101-2 Appropriate drug procedure code
24D (line 1) 2400, SV101-3 JZ modifier
24D (line 2) 2400, SV101-2 Drug administration code
24G 2400, SV104 Units of service calculated according to the applicable HCPCS code based on dosage

 

Posted 3/26/2024