Drug Wastage - JW and JZ Modifiers - JE Part A

Modifier JW - Drug amount discarded and not administered to any patient

Modifier JZ - Zero drug wasted or discarded and not administered to any patient (new July 2023)

Note: As of October 1, 2023, CMS rejects "single dose" drug claims without modifier JZ or JW, may be returned unprocessable until claims properly submitted per Discarded Drugs and Biologicals - JW Modifier and JZ Modifier Policy FAQs.

CMS requires providers with claims for unused drugs or biologicals from single use vials or single use packages appropriately discarded to submit claims with unused portions.

The units billed must correspond with the smallest dose (vial) available for purchase from the manufacturer(s) providing the appropriate patient dose, while minimizing any wastage. Always check the Medically Unlikely Edits (MUEs), if applicable (e.g., HCPCS J1745 = no more than 150 may be billed).

JW and JZ modifier does not apply when:

• Not separately payable (i.e., packaged Outpatient Prospective Payment System (OPPS) or Ambulatory Surgical Center (ASC) drugs
• Administered in the Federally Qualified Health Center (FQHC) or Rural Health Clinic (RHC) setting
• Overfilled amounts

For example: Patient required 350 mg. dose Infliximab and office purchased 4 (100 mg. single dose vials) = 400 mg. (10 mg. each)

• First line actual administered - no modifier
• Second line unused or wastage - appending modifier JW
• Document discarded drug or biological in patient's medical record

• Modifier JZ appended to drug HCPCS if zero drug wasted or discarded and not administered
• NEW for July 2023

Notation: The JW and JZ modifier requirement applies to all separately payable drugs assigned status indicators "G" (Pass-Through Drugs and Biologicals) or "K" (Nonpass-Through Drugs and Nonimplantable Biologicals, Including Therapeutic Radiopharmaceuticals), under the Outpatient Prospective Payment System (OPPS) for discarded amounts.

• Applies to all separately payable drugs assigned payment indicator "K2" (Drugs and biologicals paid separately when provided integral to a surgical procedure on Ambulatory Surgery Center {ASC} list
  • Payment based on OPPS rate in the ASC for discarded amount
• 340B covered entities (certain hospitals and providers purchasing from drug manufacturers at discounted prices) must still report JW and JZ modifiers

Resources

• Healthcare Common Procedural Coding System (HCPCS) Manual
• CMS IOM, Publication 100-04, Medicare Claims Processing Manual, Chapter 17, Section 20.1.3 and Section 70
• CMS IOM, Publication 100-02, Medicare Benefit Policy Manual, Chapter 15, Section 50
• CMS IOM, Publication 100-03, Medicare National Coverage Determination (NCD) Manual, Chapter 1, Part 4, Section 280.14
• CMS IOM Publication 100-04, Medicare Claims Processing Manual, Chapter 17, Section 40
• CMS Discarded Drugs and Biologicals - JW Modifier and JZ Modifier Policy Frequently Asked Questions (FAQs)
• Medicare Physician Fee Schedule Final Rule Summary: CY 2023
• 2023 Federal Register-Medicare Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center System Final Rule (87 FR 71988, 72082-72083, November 23, 2022
• CMS MLN Connects January 12, 2023