Key takeaways
- JW is reported on a separate claim line for the discarded amount of a separately payable Part B drug from a single-dose container or single-use package.
- JZ attests that no amount of that drug was discarded. Reporting was available from 1 January 2023 and required from 1 July 2023.
- Neither modifier applies to multi-dose vials, packaged OPPS or ASC drugs, or drugs given in RHCs and FQHCs.
- The discarded amount has to be recorded in the medical record, and claims without the right modifier can be audited or returned unprocessable.
What the JW and JZ modifiers mean
Oncology drugs are bought by the vial and billed by the unit. When a dose uses part of a single-dose vial, the rest is wasted. Medicare pays for the discarded amount in many cases, but only if the claim says so. JW is how you say so.
JZ is the opposite statement. It tells Medicare that the vial was used in full and nothing was discarded.
| Modifier | Meaning | Where it goes |
|---|---|---|
| JW | Drug amount discarded and not administered | Separate claim line, same drug code, with the discarded units |
| JZ | No drug amount discarded | On the drug line for the administered units |
Which drugs and claims it applies to
The modifiers apply to separately payable Part B drugs that the FDA label describes as single-dose or single-use. They do not apply to multi-dose vials, to packaged drugs under OPPS or ASC payment, or to drugs given in rural health clinics and federally qualified health centers. Flu, pneumococcal and COVID-19 vaccines from single-dose containers are exempt.
A worked example
This is an illustration with made-up numbers. A drug is billed per 10 mg and comes in a 100 mg single-dose vial. The patient dose is 80 mg.
- Line 1: the drug code with 8 units for the 80 mg given.
- Line 2: the same drug code with 2 units and modifier JW for the 20 mg discarded.
If the dose had been the full 100 mg, there is no waste, so the claim has one line of 10 units with modifier JZ.
Documentation and claim risk
The discarded amount has to be recorded in the medical record. CMS does not say how or by whom, and it accepts calculated amounts, including ones from software, if they are accurate. Check your MAC for local requirements.
Claims furnished from 1 July 2023 without the right modifier can be audited. Claims from 1 October 2023 without it can be returned as unprocessable until you resubmit them.
Common JW and JZ mistakes
- Leaving off JZ when a single-dose vial was used in full.
- Putting JW on the administered units instead of a separate line for the waste.
- Using the modifiers on multi-dose vials.
- Billing waste units that do not match the vial size and the dose given.
- No record of the discarded amount, so the claim cannot be supported on review.
Sources
Definitions, applicability, dates and documentation: CMS JW and JZ modifier FAQ (hosted by HHS). Commercial payers set their own waste rules, so check each payer.
JW and JZ modifiers FAQ
What is the JW modifier?
JW is reported on a separate claim line to show the amount of a separately payable Part B drug that was discarded from a single-dose container or single-use package.
What is the JZ modifier?
JZ attests that no amount of a single-dose container drug was discarded. It was required from 1 July 2023.
Do multi-dose vials need JW or JZ?
No. Neither modifier applies to multi-dose vials.
How do you bill a partly used single-dose vial?
Bill the administered units on one line and the discarded units on a second line with the same drug code and modifier JW.
What happens if I leave off JW or JZ?
Claims from 1 July 2023 can be audited, and claims from 1 October 2023 can be returned as unprocessable until they are resubmitted.