HCPCS Level II modifiers JW, Drug amount discarded/not administered to any patient, and JZ, Zero drug amount discarded/not administered to any patient, are required by the Centers for Medicare & Medicaid Services (CMS) to report drugs and biologicals that are separately payable under Medicare Part B. Modifier JW must be reported on a claim for the amount of a drug that is discarded and eligible for payment. Modifier JZ is reported to attest that no amount of drug was discarded.
Effective July 1, 2023, either modifier JW or JZ is required for all claims that bill for single-dose container drugs (single-dose vials or single-use packages) that are payable separately under Medicare Part B. This includes some pharmaceuticals and contrast agents used in medical imaging. Providers must document the amount of discarded drugs in Medicare beneficiaries’ medical records in case of an audit. Effective October 1, 2023, the policy states that any claims for drugs from single-dose containers that do not have either modifier JW or JZ appended will be returned as “unprocessable” until the claims are properly resubmitted. Note that drugs drawn from multidose containers are exempt from modifiers JW and JZ.
Modifiers JW and JZ are mostly reported on claims from a physician’s office and hospital outpatient settings for beneficiaries who receive drugs incident to a physician’s services. The requirement for modifiers JW and JZ also applies to critical access hospitals (CAHs) because drugs are separately payable in the CAH setting.
References:
https://www.cms.gov/medicare/medicare-fee-for-service-payment/hospitaloutpatientpps/downloads/jw-modifier-faqs.pdf
