CommercialJuly 1, 2025
A quick guide to understanding JW and JZ modifiers
Key takeaway
Care providers can comply with the claims submission process by accurately identifying the amounts of administered and discarded medications, correctly using JW and JZ modifiers.
Elevating claims processes with modifiers
Anthem is enhancing its claims review process to align with the commercial reimbursement policy, C‑11031 (Pharmaceutical Waste — Professional and Facility), which sets standards for single‑dose administration vials. This ensures 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 correctly use the JW and JZ modifiers to facilitate the smooth acceptance of claims.
For single‑dose vials, professional claims should include two separate claim lines: one showing the quantity administered without any modifier and another showing the quantity discarded using the JW modifier. Claims for single‑dose vials must include a line indicating the administered amount and a line for the wastage using the JW modifier to be eligible for reimbursement. Claim lines that include the JZ modifier to show that no drug amount was discarded will not need to meet this requirement.
These changes should not impact members' experiences or services.
Understanding JW and JZ modifiers
JW modifier | JZ modifier |
Use this modifier to report any discarded quantities of a drug or biological product, which supports the reimbursement of drug wastage. | Use this when there is no waste, indicating that the full dosage has been given.
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Billing guidance
- 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 dosage was used.
- For claims documentation, keep detailed records of drug administration and waste 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 commercial reimbursement policy, C‑11031 (Pharmaceutical Waste — Professional and Facility). Adhering to these guidelines will help you maintain accuracy and integrity in your billing practices.
Anthem Blue Cross and Blue Shield is the trade name of Anthem Health Plans, Inc. Independent licensee of the Blue Cross Blue Shield Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc.
MULTI-BCBS-CM-086182-25-CPN85828
PUBLICATIONS: July 2025 Provider Newsletter
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