Resolved Modifier about discarding drugs

[KateN_88735]

I read that as of 07/01/23, Medicare required modifier JZ or JW about discarding drugs. I billed J3420 - JZ for E53.8 Vit B12 Deficiency. It was denied. Do you know:
1)are these modifiers apply to certain injections only?
2) if it is the correct way to remove modifier JZ and resubmit?

Thank you

 

[Laureen Jandroep]

There have been some recent changes regarding Medicare modifiers JZ and JW:

• Modifier JW: This modifier is used to indicate any discarded amounts of a single-dose drug. Essentially, if there is any leftover medication that is not used, the JW modifier must be included in the claim to account for this unused portion1.
• Modifier JZ: This is a newer modifier introduced to indicate that the entire volume of a single-dose drug was used, with no discarded amounts. Starting from July 1, 2023, it became mandatory to use the JZ modifier on all claims for single-dose containers where there are no discarded amounts23.

These changes aim to improve the accuracy and transparency of drug usage reporting under Medicare Part B.

Here is a link to the MLN Matters article on "New JZ Claims Modifier for Certain Medicare Part B Drugs."

Here is a link to the CMS FAQ regarding "Discarded Drugs and Biologicals – JW Modifier and JZ Modifier Policy"

Beginning July 1, all claims for single-dose Part B drugs administered to original Medicare patients must include a JW modifier to indicate unused volume of drug or a new JZ modifier to indicate the entire volume of the drug was used.

This policy was included in the 2023 Medicare Physician Fee Schedule Final Rule as CMS began implementation of a new law that requires manufacturers to rebate Medicare for un-sued, discarded volume of Part B drugs. Additional information on the policy is available on the ASRS website.

The Medicare Administrative Contractor First Coast Service Options provides helpful billing examples here. If you have questions, please contact ASRS Director of Practice Management, Monica Horton.

Posted June 22, 2023

To answer your questions

1)are these modifiers apply to certain injections only?

In the FAQ form CMS Question 7 has this information. I'd also read Question 8.

Q7. To which drugs does the policy apply? How can a provider or supplier identify a drug that must be billed using the JW or JZ modifier?

A7. In general, the JW and JZ modifier policy applies to all drugs separately payable under Medicare Part B that are described as being supplied in a “single-dose” container or “single-use” package based on FDA-approved labeling. The use of these modifiers is not appropriate for drugs that are from multipledose containers.

Even if a drug is excluded from the definition of “refundable single-dose container or single-use package drug” (and not subject to the discarded drug refund), for example, multiple source drugs, claims for such drugs furnished from a single-dose container are still required to use the JW and JZ modifiers.

Generally, in the physician office, all drugs paid incident to a physician service are separately payable under Medicare Part B. Therefore, in general, all such drugs that are described as being supplied in a “single-dose” container or “single-use” package are subject to the JW and JZ modifier in the physician office.

In the hospital outpatient department and the Ambulatory Surgical Center (ASC), only the separately payable drugs are subject to the JW and JZ modifier requirement. Please see below under “Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System.

”The JW and JZ modifiers apply to separately payable single-dose drugs administered in the ESRD setting that are not renal dialysis service drugs or biological products provided for the treatment of ESRD. Either the JW or JZ modifier is reported in conjunction with the AY modifier.

The JW and JZ modifier policy does not apply for drugs that are not separately payable, such as packaged OPPS or ASC drugs, or drugs administered in the FQHC or RHC setting.

The JW and JZ modifiers are not required for vaccines described under section 1861(s)(10) of the Act that are furnished from single-dose containers. Since the influenza, pneumococcal, and COVID–19 vaccines, specified in section 1861(s)(10) of the Act, are often roster billed by mass immunizers, and roster billing cannot accommodate modifiers, it would be impractical to require the JW and JZ modifiers for such vaccines. Such a requirement would likely result in substantial operational issues for mass immunizers and impair patient access to these vaccines.

2) if it is the correct way to remove modifier JZ and resubmit?

I think standard claim revisions would apply if you need to make a change to a code or modifier.

 

[KateN_88735]

There have been some recent changes regarding Medicare modifiers JZ and JW:

• Modifier JW: This modifier is used to indicate any discarded amounts of a single-dose drug. Essentially, if there is any leftover medication that is not used, the JW modifier must be included in the claim to account for this unused portion1.
• Modifier JZ: This is a newer modifier introduced to indicate that the entire volume of a single-dose drug was used, with no discarded amounts. Starting from July 1, 2023, it became mandatory to use the JZ modifier on all claims for single-dose containers where there are no discarded amounts23.

These changes aim to improve the accuracy and transparency of drug usage reporting under Medicare Part B.

Here is a link to the MLN Matters article on "New JZ Claims Modifier for Certain Medicare Part B Drugs."

Here is a link to the CMS FAQ regarding "Discarded Drugs and Biologicals – JW Modifier and JZ Modifier Policy"



To answer your questions

In the FAQ form CMS Question 7 has this information. I'd also read Question 8.




I think standard claim revisions would apply if you need to make a change to a code or modifier.

Thank you Laureen for your reply.