Policy Updates Reimbursement PoliciesCommercialDecember 1, 2023

Reimbursement policy update: Pharmaceutical Waste – Professional and Facility

Beginning January 1, 2024, Empire became Anthem. This article, published under the former brand, now applies to Anthem.

Effective January 1, 2024, Empire BlueCross BlueShield updated the Related Coding section of the Pharmaceutical Waste – Professional and Facility reimbursement policy to include Modifier JZ (zero drug amount discarded or not administered to any patient) as a new informational modifier.

As a reminder, the intent of this policy is to require providers to use the most cost-effective vial or combination of vials of pharmaceutical when procuring and preparing a dose for administration to avoid pharmaceutical wastage. This applies to any non-self-administered drug or biologic dosage prepared from a single-dose vial (SDV).

For specific policy details, visit empireblue.com/provider/policies/reimbursement/.

Services provided by Empire HealthChoice HMO, Inc. and/or Empire HealthChoice Assurance, Inc., licensees of the Blue Cross Blue Shield Association, an association of independent Blue Cross and Blue Shield plans.

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PUBLICATIONS: December 2023 Provider Newsletter