Drug Multipliers JZ JW On SDV

Quest ion:

We are looking for some guidance JZ JW with multi-dose vials. The guidelines say that JZ and JW apply to all status G and Kdrugs However, JW is only applicable to SDV(single dose vials) We do have some MDVs that are status G and K. How does the insurance payer know these are MDV?Will they deny reimbursement if no JZ is attached?

Answ er:

Wastage (JW) or no wastage (JZ) modifiers are required for only single-use vials and packages of drugs and biologicals when the drug is separately payable. Those drugs would be payable as indicated by the Status Indicator G (pass-through, paid under OPPS) or K (nonpass-through, paid under OPPS).

Per the CMSJW-Modifier-FAQ, which is linked in CMSIssues JW Modifier Reporting FAQ:

Quest ion:

We are looking for some guidance JZ JW with multi-dose vials The guidelines say that JZ and JW apply to all status G and Kdrugs. However, JW is only applicable to SDV(single dose vials). We do have some MDVs that are status G and K. How does the insurance payer know these are MDV?Will they deny reimbursement if no JZ is attached?

Answ er:

Wastage (JW) or no wastage (JZ) modifiers are required for only single-use vials and packages of drugs and biologicals when the drug is separately payable Those drugs would be payable as indicated by the Status Indicator G (pass-through, paid under OPPS) or K (nonpass-through, paid under OPPS).

Per the CMSJW-Modifier-FAQ, which is linked in CMSIssues JW Modifier Reporting FAQ:

Payers receive the NDC# of the drugs administered through the claim The last two digits of the NDC# provide the product size.

Medicare states they intend on turning on an edit in October that will reject claims when a single-use vial does not include either the JZ modifier on the HCPCScode or a second claim line with the wasted units and the HCPCScode appended with modifier JW

New Modifier JZ Required When Reporting Payable Drug

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