Published on April 7, 2023
By: Ronda Tews
Have you heard about the new JZ modifier requirement from the Centers for Medicare & Medicaid Services (CMS)? The JZ modifier is an HCPCS Level II claim modifier to report that no amount of drug was discarded and the claim is eligible for payment. The modifier should only be used for claims that bill for single-dose container drugs. Starting on July 1, 2023, the JZ modifier is required for single-dose drugs separately payable under Medicare Part B if no JW modifier amount is reported.
Now, let’s consider how drug wastage is reported using the JW modifier. The JW modifier requirement for Medicare billing went into effect January 1, 2017, and is used to indicate the amount of unused and discarded drugs from single-dose containers or single-use packages. Not only is the submission of JW modifier required, but also providers must document the amount of discarded single-dose container drugs in patients’ medical records for drugs payable under Medicare Part B. This documentation can easily be accomplished within the ModMed® EMA® software. Additionally, the soon-to-be-required JZ modifier is currently available for use in ModMed EHR products.
CMS has announced that claims failing to report the JW or JZ modifiers may be subject to provider audits, starting July 1, 2023. Beginning October 1, 2023, claims for drugs from single-dose containers not using these modifiers as appropriate may be returned as unprocessable until the claims are properly resubmitted.
Want more information about the JW and JZ modifier requirements?
Here are some additional resources to help you understand the latest JW and JZ modifier guidelines:
How ModMed Can Help
Our EHR software currently allows you to document using the JW and JZ modifiers, and all specific drug and biological plans are expected to be updated with the JZ modifier and ready to go on or before July 1, 2023.
Concerned that your EHR vendor isn’t keeping up with the latest regulations? Now is a great time to switch to one of our EHR systems certified under the Cures Act. They generate suggested codes and chart notes based on your documentation.
About Ronda Tews
ModMed Senior Director of Billing and Coding Compliance Ronda Tews is a Certified Professional Coder (CPC), Certified in Healthcare Compliance (CHC) and a Certified Coding Specialist-Physician (CCS-P). Ronda brings over three decades of robust healthcare compliance experience to the organization and manages the company’s billing and coding compliance program.
Prior to her time at ModMed, Ronda held other roles related to coding, compliance and training. She did healthcare consulting, managed provider compliance for a large health plan, and created a fraud, waste and abuse program. Ronda has also conducted E/M audits on physicians and mid-level providers, established internal auditing and monitoring, taught basic coding classes to coworkers, and provided E/M documentation training to physicians and mid-level providers. Additionally, she has implemented compliance education and training programs, managed a compliance report line, and conducted compliance auditing and monitoring. At Missouri State University, she provided coding and documentation education to the physician assistant students in the physician assistant program at the university. She has also served as a Quality Improvement Analyst and worked as a Corporate Compliance Project Manager for a large health system.
The information provided is for general informational purposes only and does not constitute legal advice. Please consult with a legal or compliance advisor to discuss your specific regulatory compliance needs.