License for Use of "Physicians' Current Procedural Terminology", (CPT) Fourth Edition

End User/Point and Click Agreement: CPT codes, descriptions and other data only are copyright 2009 American Medical Association (AMA). All Rights Reserved (or such other date of publication of CPT). CPT is a trademark of the AMA.

You, your employees and agents are authorized to use CPT only as contained in the following authorized materials including but not limited to CGS fee schedules, general communications, Medicare Bulletin, and related materials internally within your organization within the United States for the sole use by yourself, employees, and agents. Use is limited to use in Medicare, Medicaid, or other programs administered by the Centers for Medicare & Medicaid Services (CMS). You agree to take all necessary steps to insure that your employees and agents abide by the terms of this agreement.

Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CPT for resale and/or license, transferring copies of CPT to any party not bound by this agreement, creating any modified or derivative work of CPT, or making any commercial use of CPT. License to use CPT for any use not authorized here in must be obtained through the AMA, CPT Intellectual Property Services, 515 N. State Street, Chicago, IL 60610. Applications are available at the AMA website.

This product includes CPT which is commercial technical data and/or computer data bases and/or commercial computer software and/or commercial computer software documentation, as applicable which were developed exclusively at private expense by the American Medical Association, 515 North State Street, Chicago, Illinois, 60610. U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer data bases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2)(June 1995) and/or subject to the restrictions of DFARS 227.7202-1(a)(June 1995) and DFARS 227.7202-3(a)June 1995), as applicable for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14 (June 1987) and/or subject to the restricted rights provisions of FAR 52.227-14 (June 1987) and FAR 52.227-19 (June 1987), as applicable, and any applicable agency FAR Supplements, for non-Department Federal procurements.

AMA Disclaimer of Warranties and Liabilities.

CPT is provided "as is" without warranty of any kind, either expressed or implied, including but not limited to, the implied warranties of merchantability and fitness for a particular purpose. AMA warrants that due to the nature of CPT, it does not manipulate or process dates, therefore there is no Year 2000 issue with CPT. AMA disclaims responsibility for any errors in CPT that may arise as a result of CPT being used in conjunction with any software and/or hardware system that is not Year 2000 compliant. No fee schedules, basic unit, relative values or related listings are included in CPT. The AMA does not directly or indirectly practice medicine or dispense medical services. The responsibility for the content of this file/product is with CGS or the CMS and no endorsement by the AMA is intended or implied. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this file/product. This Agreement will terminate upon notice if you violate its terms. The AMA is a third party beneficiary to this Agreement.

CMS Disclaimer

The scope of this license is determined by the AMA, the copyright holder. Any questions pertaining to the license or use of the CPT must be addressed to the AMA. End Users do not act for or on behalf of the CMS. CMS DISCLAIMS RESPONSIBILITY FOR ANY LIABILITY ATTRIBUTABLE TO END USER USE OF THE CPT. CMS WILL NOT BE LIABLE FOR ANY CLAIMS ATTRIBUTABLE TO ANY ERRORS, OMISSIONS, OR OTHER INACCURACIES IN THE INFORMATION OR MATERIAL CONTAINED ON THIS PAGE. In no event shall CMS be liable for direct, indirect, special, incidental, or consequential damages arising out of the use of such information or material.

This license will terminate upon notice to you if you violate the terms of this license. The AMA is a third party beneficiary to this license.

POINT AND CLICK LICENSE FOR USE OF "CURRENT DENTAL TERMINOLOGY", ("CDT")

End User License Agreement

THE LICENSE GRANTED HEREIN IS EXPRESSLY CONDITIONED UPON YOUR ACCEPTANCE OF ALL TERMS AND CONDITIONS CONTAINED IN THIS AGREEMENT. BY CLICKING BELOW ON THE BUTTON LABELED "I ACCEPT", YOU HEREBY ACKNOWLEDGE THAT YOU HAVE READ, UNDERSTOOD AND AGREED TO ALL TERMS AND CONDITIONS SET FORTH IN THIS AGREEMENT.

IF YOU DO NOT AGREE WITH ALL TERMS AND CONDITIONS SET FORTH HEREIN, CLICK BELOW ON THE BUTTON LABELED "I DO NOT ACCEPT" AND EXIT FROM THIS COMPUTER SCREEN.

IF YOU ARE ACTING ON BEHALF OF AN ORGANIZATION, YOU REPRESENT THAT YOU ARE AUTHORIZED TO ACT ON BEHALF OF SUCH ORGANIZATION AND THAT YOUR ACCEPTANCE OF THE TERMS OF THIS AGREEMENT CREATES A LEGALLY ENFORCEABLE OBLIGATION OF THE ORGANIZATION. AS USED HEREIN, "YOU" AND "YOUR" REFER TO YOU AND ANY ORGANIZATION ON BEHALF OF WHICH YOU ARE ACTING.

Subject to the terms and conditions contained in this Agreement, you, your employees, and agents are authorized to use CDT-4 only as contained in the following authorized materials and solely for internal use by yourself, employees and agents within your organization within the United States and its territories. Use of CDT-4 is limited to use in programs administered by Centers for Medicare & Medicaid Services (CMS). You agree to take all necessary steps to ensure that your employees and agents abide by the terms of this agreement. You acknowledge that the ADA holds all copyright, trademark and other rights in CDT-4. You shall not remove, alter, or obscure any ADA copyright notices or other proprietary rights notices included in the materials.
Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CDT-4 for resale and/or license, transferring copies of CDT-4 to any party not bound by this agreement, creating any modified or derivative work of CDT-4, or making any commercial use of CDT-4. License to use CDT-4 for any use not authorized herein must be obtained through the American Dental Association, 211 East Chicago Avenue, Chicago, IL 60611. Applications are available at the American Dental Association website.
Applicable Federal Acquisition Regulation Clauses (FARS)\Department of Defense Federal Acquisition Regulation Supplement (DFARS) Restrictions Apply to Government use. Please click here to see all U.S. Government Rights Provisions.
ADA DISCLAIMER OF WARRANTIES AND LIABILITIES. CDT-4 is provided "as is" without warranty of any kind, either expressed or implied, including but not limited to, the implied warranties of merchantability and fitness for a particular purpose. No fee schedules, basic unit, relative values or related listings are included in CDT-4. The ADA does not directly or indirectly practice medicine or dispense dental services. The sole responsibility for the software, including any CDT-4 and other content contained therein, is with (insert name of applicable entity) or the CMS; and no endorsement by the ADA is intended or implied. The ADA expressly disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this file/product. This Agreement will terminate upon notice to you if you violate the terms of this Agreement. The ADA is a third-party beneficiary to this Agreement.
CMS DISCLAIMER. The scope of this license is determined by the ADA, the copyright holder. Any questions pertaining to the license or use of the CDT-4 should be addressed to the ADA. End users do not act for or on behalf of the CMS. CMS DISCLAIMS RESPONSIBILITY FOR ANY LIABILITY ATTRIBUTABLE TO END USER USE OF THE CDT-4. CMS WILL NOT BE LIABLE FOR ANY CLAIMS ATTRIBUTABLE TO ANY ERRORS, OMISSIONS, OR OTHER INACCURACIES IN THE INFORMATION OR MATERIAL COVERED BY THIS LICENSE. In no event shall CMS be liable for direct, indirect, special, incidental, or consequential damages arising out of the use of such information or material.

The license granted herein is expressly conditioned upon your acceptance of all terms and conditions contained in this agreement. If the foregoing terms and conditions are acceptable to you, please indicate your agreement by clicking below on the button labeled "I ACCEPT". If you do not agree to the terms and conditions, you may not access or use the software. Instead, you must click below on the button labeled "I DO NOT ACCEPT" and exit from this computer screen.

Jurisdiction 15 A/B MAC for the states of KY & OH

IVR: 866.290.4036 Customer Support & myCGS Help: 866.276.9558

Home Medicare Home JB DME JC DME J15 Part A J15 Part B J15 HHH People with Medicare

myCGS Portal

Customer Service

Appeals/Redeterminations

Electronic Data Interchange (EDI)

FAQs

Fee Schedules/Reimbursement

Forms

Innovations

LCDs / Medical Policies

Medical Review

News & Publications

Overpayments & Refunds

Prior Authorization

Provider Enrollment

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

Resources