By: Rupal Trivedi, Senior Manager, Physician Services
The Centers for Medicare and Medicaid Services (CMS) has announced a new claims modifier, JZ, that will be used for certain Medicare Part B drugs. Effective July 1, 2023, providers and suppliers must report the JZ modifier on all claims that bill for drugs from single-dose containers separately, payable under Medicare Part B when there are no discarded amounts. However, the JW modifier will still be in use for drugs that are billed in full vials or single-use packages but where the full vial or package was not used. Providers and suppliers should indicate the amount of the drug that was administered to the patient, as well as the amount that was discarded using the JW modifier.
What is the purpose of the JZ modifier?
The JZ modifier is intended to ensure that Medicare Part B drugs are being used in accordance with their FDA-approved indications. This will help to prevent the use of drugs for off-label purposes, which can be dangerous and costly. By using the JZ modifier, providers will be able to indicate that they are using the drug as intended by the FDA and that the use is, therefore, appropriate for reimbursement.
The definition for both modifiers is as follows:
The implementation of the JZ modifier is an important step in ensuring that Medicare Part B drugs are being used appropriately and in accordance with their FDA-approved indications. By requiring providers to indicate that a drug was used as intended by the FDA, CMS can help to prevent the use of drugs for off-label purposes, which can be dangerous and costly. Providers should be aware of the implementation date of July 1, 2023, and should prepare to use the JZ modifier for certain Medicare Part B drugs.
Claims that do not report the modifiers as appropriate on or after Oct. 1 may be returned as unprocessable.
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Resources:
https://www.cms.gov/medicare/medicare-fee-for-service-payment/hospitaloutpatientpps/downloads/jw-modifier-faqs.pdf
Article - Billing and Coding: JW and JZ Modifier Billing Guidelines (A55932) (cms.gov)
MM13056 - New JZ Claims Modifier for Certain Medicare Part B Drugs (cms.gov)