Proper Use of Modifiers JW and JZ
National Government Services Provider Contact Center has received several inquiries regarding claim denials related to the use of the JW and JZ modifier for drugs/biologicals.
As a reminder, effective 1/1/2017 the JW modifier is required to be reported in order to identify claims with unused drugs/biologicals from single-dose containers.
The JZ modifier, for claims submitted 7/1/2023 and forward, is required to be reported to identify claims with zero unused drugs/biologicals from single-dose containers.
Note: It would not be appropriate to report both modifiers on the same date of service for the same drug/biological.
Please see the billing examples for use below, and for more details, review our Drugs and Biologicals – Coverage and Billing article.
JW Modifier Example
| 1500 Claim Form Field | 837P v5010 Loop & Segment | Information Required |
|---|---|---|
| 19 | 2300 or 2400, NTE02 May also use 2400, SV101-7 |
NDC, invoice cost, dosage |
| 24D (line 1) | 2400, SV101-2 | Drug HCPCS code |
| 24D (line 2) | 2400, SV101-2 | The same drug HCPCS code |
| 24D (line 2) | 2400, SV101-3 | JW modifier |
| 24D (line 3) | 2400, SV101-2 | Drug administration code |
| 24G | 2400, SV104 | Units of service – calculated according to the applicable HCPCS code based on dosage |
JZ Modifier Example
| 1500 Claim Form Field | 837P v5010 Loop & Segment | Information Required |
|---|---|---|
| 19 | 2300 or 2400, NTE02 May also use 2400, SV101-7 |
NDC, invoice cost, dosage |
| 24D (line 1) | 2400, SV101-2 | Drug HCPCS code |
| 24D (line 1) | 2400, SV101-3 | JZ modifier |
| 24D (line 2) | 2400, SV101-2 | Drug administration code |
| 24G | 2400, SV104 | Units of service – calculated according to the applicable HCPCS code based on dosage |
Posted 10/30/2023