Billing and Coding: JW and JZ Modifier Billing Guidelines (A55932) - R5 - Effective January 10, 2023

This coverage article has been revised and published for notice under contract numbers: 02102 (AK), 02202 (ID), 02302 (OR), 02402 (WA), 03102 (AZ), 03202 (MT), 03302 (ND), 03402 (SD), 03502 (UT), and 03602 (WY).

Effective Date: January 10, 2023

Summary of Article Changes:

Updated Article Billing and Coding: JW and JZ Modifier Billing Guidelines

Updated guidance in the Article Text section:

  • Changed the sentence: "This article addresses the required use of the JW and JZ modifier to indicate drug wastage."
  • Added: "Effective July 1, 2023, Medicare requires the JZ modifier on all claims for single-dose containers where there are no discarded amounts."
  • Added: To submit claims for a non-discarded claim, submit one complete claim line.
    • HCPCS code for drug given
    • JZ modifier to indicate no waste
    • Number of units given to the patient
    • Calculate submitted price for the amount given
  • Removed MLN Matter Article MM9603 under sources as this is no longer published.
  • Updated Title of Source #3: Discarded Drugs and Biologicals - JW Modifier and JZ Modifier Policy Frequently Asked Questions (cms.gov)

Updated CPT/HCPCS Modifier: added JZ modifier

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