A quick guide to understanding JW and JZ modifiers

Key takeaway

Care providers can improve the claim submission process by accurately submitting claims, identifying the amounts of administered and discarded medications, and properly using JW and JZ modifiers. These changes should not impact members' experiences or services.

Elevating claims processes with modifiers

Anthem is enhancing its claims review process to align with Medicare standards for single‑dose administration vials. This aims to ensure accurate billing and reimbursement by properly accounting for any unused medication in single‑dose vials and verifying the selection of an appropriate vial size for patient treatment. Care providers should ensure they use the JW and JZ modifiers correctly to facilitate the smooth acceptance of claims.

Understanding JW and JZ modifiers

Billing guidelines for accurate Medicare compliance:

• When waste occurs, two claim lines should be included. One line must indicate the amount administered without a modifier, while a separate line should report the discarded amount of the drug using the JW modifier.
• When there is no waste, one claim line should be included to report the JZ modifier, confirming that the entire drug dose was used.
• For claims documentation, maintain comprehensive records of drug administration and wastage to ensure consistency with billed units.

Reminder

Care providers must submit claims with separate lines for both the administered and discarded quantities. Attach the JW modifier to the line for discarded amounts and use the JZ modifier when no wastage is present.

Learn more

For detailed information, refer to the article, Billing and Coding: JW and JZ Modifier Billing Guidelines, on cms.gov. Following these guidelines will help you maintain accuracy and integrity in your billing practices.