Article - Billing and Coding: JW and JZ Modifier Billing Guidelines (A55932)

CMS National Coverage PolicyN/AArticle TextThis article addresses the required use of the JW and JZ modifier to indicate drug wastage. CMS and Noridian encourage physicians, hospitals and other providers and suppliers to administer drugs and biologicals to patients in such a way that these are used most efficiently, in a clinically appropriate manner (IOM100-4 Chapter 17, Sections 40-40.1).When a physician, hospital or other provider or supplier must discard the remainder of a single-use vial or other single-use package after administering a dose/quantity of the drug or biological to a Medicare patient, the program provides payment for the discarded drug or biological amount as well as the dose administered, up to the amount of the drug or biological as indicated on the vial or package label.The following serves to clarify billing guidelines and provide examples of proper billing with a single-dose vial and discarded drug billing:Providers and hospitals are reminded to ensure amounts of drugs administered to patients are accurately reported in terms of the dosage specified in the long descriptor for the applicable HCPCS codes. This is because the short descriptors are limited to 28 characters so they do not always capture the complete description of the drug.When submitting Medicare claims, units of service (UOS) should be reported in multiples of the dosage included in the long HCPCS code descriptor. If the dosage given is not a multiple of the number provided in the HCPCS code description, the provider shall round up to the nearest whole number in order to express the number as a multiple.If the provider must discard the remainder of a single-use vial or other package after administering the prescribed dosage of any given drug, Medicare may cover the amount of the drug discarded along with the amount administered. The following elements must be followed in order for the discarded amount to be covered.The vial must be a single-use vial. Multi-use vials are not subject to payment for any discarded amounts of the drug.Any amount of drug billed as wastage from a single-dose vial, must actually be discarded and may not be used for another patient regardless of whether or not that other patient has Medicare.Please clearly document in the patient's medical record the actual dose administered in addition to the exact amount wasted and the total amount of the vial is labeled to contain. This kind of detailed documentation helps benefit your practice by justifying your billing in the event a medical review should occur.Medicare requires discarded drugs be reported with the JW modifier on a separate line, the total number of discarded units reported should not include amounts of the drug also included on the administered line due to the rounding up of units.Please remember to verify the milligrams administered to the patient and then convert to the proper units for billing.Due to single-use vial type, the provider may bill for the amount administered as well as the amount appropriately discarded. The discarded amount is reported with the JW modifier. The JW modifier is only applied to the amount of the drug or biological that is discarded. A situation in which the JW modifier is not permitted is when the actual dose of the drug or biological administered is less than the billing unit. (See "Medicare Claims Processing Manual," Chapter 17, Section 40). As an example, if one billing unit for a drug is equal to 10mg of the drug in a single-use vial, and a 7mg dose is administered to a patient resulting in 3mg remaining drug being discarded, then the 7mg dose is billed using one UOS that represents 10mg on a single line item. The single line item would be processed for payment of the total 10mg of the drug administered and discarded. Billing another unit on a separate line item with the JW modifier for the discarded 3mg of the drug is not permitted because it would result in an overpayment. Therefore, when the billing unit is equal or greater than the total actual dose and the amount discarded, the use of the JW modifier is not permitted.Effective July 1, 2023, Medicare requires the JZ modifier on all claim for single-dose containers where there are no discarded amounts.To submit claims for a waste-required claim, submit two complete claim lines.Claim line #1:HCPCS code for drug givenNo modifierNumber of units given to the patientCalculated submitted price for ONLY the amount of drug givenClaim line #2:HCPCS code for drug wastedJW modifier to indicate wasteNumber of units wastedCalculated submitted price for ONLY the amount of drug wastedTo submit claims for a non-discarded claim, submit one complete claim line.HCPCS code for drug givenJZ modifier to indicate no wasteNumber of units given to the patientCalculate submitted price for the amount givenSources:CR 9603-JW Modifier: Drug amount discarded/not administered to any patientInternet Only Manual (IOM) 100-4-Claims Processing Manual; Chapter 17-Drugs and Biologicals; Sections 40-40.1Discarded Drugs and Biologicals - JW Modifier and JZ Modifier Policy Frequently Asked Questions (cms.gov)