JZ - JA DME

Effective July 1, 2023, providers and suppliers are required to report the JZ modifier on all claims that bill for drugs separately payable under Medicare Part B when there are no discarded amounts from single-dose containers or single-use packages.

• The JZ modifier is required on applicable claims beginning July 1, 2023

When the HCPCS code UOS is equal to or greater than the total of the actual dose and the amount discarded, use of the JW modifier is not permitted. If the quantity of drug administered is less that a full UOS, the billed UOS is rounded to the appropriate UOS. For example:

• A single use vial is labeled to contain 100 mg of a drug.
• The drug's HCPCS code UOS is 1 UOS = 100 mg.
• 70 mg of the 100 mg in the vial are administered to the beneficiary.
• 30 mg remaining in the vial are discarded.
• The 70 mg dose is billed correctly by rounding up to one UOS (representing the entire 100 mg vial) on a single line item.
• The single line item of 1 UOS (with the JZ modifier) would be processed for payment of the combined total 100 mg of administered and discarded drug.
• The discarded 30 mg must not be billed as another 1 UOS on a separate line item with the JW modifier. Billing an additional 1 UOS for the discarded drug with the JW modifier is incorrect billing and will result in an overpayment.

Resources

• CMS Internet Only Manual (IOM), Publication 100-04, Medicare Claims Processing Manual, Chapter 17, Section 40
• Medicare Program Discarded Drugs and Biologicals - JW Modifier and JZ Modifier Policy Frequently Asked Questions (cms.gov)