What you need to know for JZ and JW modifiers under the 2023 Medicare Physician Fee Schedule
The Centers for Medicare & Medicaid Services (CMS) has added an extra step for all outpatient settings when there are no discarded amounts from single use vials or single use packages payable under Part B for which the JW modifier would be required. If you do not comply with the new rule CMS will not process your claims after October 2023.
The final rule for the 2023 Medicare Physician Fee Schedule (MPFS) made a significant change for coding if your practice bills drugs under Medicare Part B. Our team of experts highly recommends that you start reading beginning at page 866 of the Final Rule if you bill for drugs. https://www.federalregister.gov/d/2022-23873
The JW modifier has been required since 2017 and practices understand the JW modifier and have been using it in their claims. The JW modifier is a modifier used on a Medicare Part B drug claim to report the amount of drug or biological that is discarded and eligible for payment under the discarded drug policy.
What is the JZ modifier?
Effective Jan. 1, 2023, (but not required until July 1, 2023), the JZ modifier would be required, on the same service line as the drug CPT code, when there are no discarded amounts from single use vials or single use packages payable under Part B for which the JW modifier would be required if there were discarded amounts.
Why does my practice need to use the JZ modifier if we are already using the JW modifier?
CMS is looking for a modifier on every use of a single-does vial – whether it’s JZ or JW. Beginning Oct. 1, 2023, CMS will deny claims that are not appropriately using the modifiers.
Can you provide an example of JW versus JZ modifier?
- Velcade (J90041) will always be billed with a JW modifier as an entire vial is never given.
- Aloxi (J2468) is always given in its entirety (from a single dose vial), so the practice would bill with a JZ modifier as there is no waste.
What does my practice need to do?
- Educate all staff on the JZ and JW modifier.
- It is recommended that you review the above indicated pages of the Final Rule to answer your questions and understand CMS’ plans.
- Review your practice’s billing process to understand what single dose or single use packages are utilized in your infusion area and identify all drugs that fall under the single dose vial billing requirement.
- Work with your EHR vendor and billing team to ensure you have the workflow process in place to accurately begin using the modifiers.
- Check with your regional MAC or specialty society if you have questions regarding specific drugs or immunizations.
Getting those modifiers in order may take some time, so practices are encouraged to start after the first of the year to work out any change in processes. Our team of experts is ready to answer your questions about this new regulation, or help you with billing and coding or your submissions under the Quality Payment Program. For more information, reach out to them at InfoDiveSupport@intrinsiq.com or QREG@intrinsiq.com.