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June 27, 2023

Billing and Coding: JW and JZ Modifier Guidelines

When a provider or supplier is required to discard the remainder of a single-use vial after administering a dose of the drug or biological to a Medicare patient, payment is provided for the discarded drug or biological amount as well as the administered dose, up to the amount of the drug or biological indicated on the vial label.

This article clarifies billing guidelines for use of the JW and JZ modifiers:

  • Providers must ensure amounts of drugs administered are accurately reported in terms of the dosage specified in the long descriptor of the HCPCS code.
  • When submitting claims, units of service are to be reported in multiples of the dosage included in the HCPCS code descriptor. If dosage given is not a multiple of the number provided in the HCPCS code description, the provider is to round up to the nearest whole number to express the number as a multiple.
  • If the provider must discard the remainder of a single-use vial after administering the prescribed dosage, Medicare may cover the amount discarded along with the administered amount. For the discarded amount to be covered:
    1. Vial must be a single-use vial. Multi-use vials are not subject to payment for discarded amounts of the drug.
    2. Units billed should correspond with the smallest vial available for purchase from the manufacturer that could provide the appropriate dose for that patient to minimize wastage.
      1. Example: If a medication is supplied as 100mg in a 2mL single-use vial or 400mg in an 8mL single-use vial and the provider administers 300mg. The most efficient way to administer this dose is with three-100mg vials. The incorrect method would be utilizing the 400mg single-use vial and discarding the remaining 100mg in that vial as it would not be the most efficient way to minimize drug wastage.
      2. Example: if the dose of the drug (1 unit=10mg) administered had been 305mg, 31 units would be billed and 9 units would be billed on a separate line with a JW modifier.
  • It must be clearly documented in the patient's medical record the actual dose administered in addition to the exact amount wasted and the total amount on the vial's label.
  • Medicare requires discarded drugs be reported with a JW modifier on a separate line from the units administered.
  • Due to single-use vial type, providers may bill the amount administered in addition to the amount properly discarded. Ensuring to report the discarded amount with a JW modifier. A situation that the JW modifier would not be appropriate is when the actual administered dose of the drug or biological is less than the billing unit. Example: if 1 unit for a drug is equal to 10mg in a single-use vial, and a 7mg dose is administered with the remaining 3mg being discarded, then the 7mg dose would be billed using 1 UOS representing 10mg on a single line item. This would then be processed for payment of the total 10mg of the drug administered and discarded. Billing any additional unit on a separate line with the JW modifier for the discarded 3mg would not be appropriate because it would result in an overpayment. Therefore, when the unit(s) billed is equal or greater than the total actual dose and amount discarded, use of the JW modifier is not acceptable.
  • Effective July 1, 2023, Medicare requires the JZ modifier on all claims for single-dose containers where there are no discarded amounts.

When submitting claims for waste-required claims, submit with two claim lines.

Claim line #1:

  • HCPCS code for drug or biological administered
  • Number of units administered to patient
  • Calculated submitted price for ONLY amount administered

Claim line #2:

  • HCPCS code for drug or biological wasted
  • JW modifier to indicate waste
  • Number of units wasted
  • Calculated submitted price for ONLY amount wasted

When submitting claims for drugs/biologicals with none being discarded, submit one claim line.

  • HCPCS code for drug or biological administered
  • JZ modifier (in addition to any additional necessary modifiers) to indicate no waste
  • Number of units administered
  • Calculate submitted price for the amount administered

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