By now, most practices should be aware of the JW and JZ modifiers, which you are to append to codes for single-dose drug containers that you bill to Medicare Part B.
Report modifier JW when part of the drug is discarded and not administered to a patient. Use JZ to attest when there were no discarded amounts. When JW is appended, remember to report the discarded amount on the claim.
Medicare began requiring you to use the modifiers as appropriate last month, and starting Oct. 1, single-dose drug codes that don’t have a JW or JZ appended will be returned as unprocessable.
CMS recently expanded its
FAQs on JW/JZ to specify, among other things, settings where the modifiers should be reported. For example, “the JW and JZ modifiers are mostly reported on claims from the physician’s office and hospital outpatient settings for beneficiaries who receive drugs incident to physicians’ services,” CMS states.
Other settings and stipulations:
- Critical access hospitals (CAH) should plan to use them “since drugs are separately payable in the CAH,” according to the CMS Q&A document.
- Pharmacies only need to use JW and JZ for cases when drugs are actually administered, not merely dispensed.
- End-stage renal disease (ESRD) facilities should append the modifiers only for drugs in single-dose containers that are not renal dialysis service drugs or biological products provided for the treatment of ESRD, CMS states.
- Rural health clinics (RHC) or federally qualified health centers (FQHC) should not use the modifiers because “drugs administered in RHCs and FQHCs are generally not separately payable under Part B.
- Hospital inpatient claims billed under the Inpatient Prospective Payment System – don’t use the JW or JZ.
- In outpatient hospitals and ambulatory surgery centers, only separately payable drugs administered via single-dose vials require the modifiers, CMS notes.
In addition, providers don’t have to worry about appending the modifiers to vaccines described under section 1861(s)(10) of the Social Security Act, including influenza, pneumococcal and Covid-19 vaccines. These injections “are often roster billed by mass immunizers, and roster billing cannot accommodate modifiers,” the agency notes.
Practices can find additional details, such as the specifics of how the modifiers should appear on the claim and documentation requirements in the
CMS FAQ.