ASC Coding Guidance for Modifiers JW and JZ

Drugs and biologicals are available in both single-use and multi-dose vials/packages. When a single-use vial/package is selected, there are times when not all of the drug or biological is used. The remaining product must be discarded.

Medicare will reimburse ASCs for the wasted amount when billed with modifier JW. The total amount used is reported with the appropriate HCPCS code with no modifier, and the remaining wasted amount is reported on a separate line with the same HCPCS code with modifier JW appended.

If the entire single-use vial/package is used and nothing is wasted, the HCPCS code is reported with modifier JZ.

When billing for a single-use vial/package, the documentation must include the actual dose administered, the exact amount wasted (if any), and the total amount of the vial. The use of a multi-dose vial/package is coded based on the amount given to the patient with no modifiers.

JW and JZ Modifier Definitions

The definitions for the JW and JZ modifiers are as follows:

• JW: Drug amount discarded/not administered to any patient
• JZ: Zero drug amount discarded/not administered to any patient

Here are examples of how to use these modifiers:

• Vabysmo single-dose vial contains 6 mg
  • J2777 is reported with 1 unit per 0.1 mg
  • 4 mg of single-dose vial is injected into patient with 2 mg of waste
  • Report J2777 x 40 units (no modifier) on line 1
  • Report J2777-JW x 20 units on line 2 for the wasted amount

• Vabysmo single-dose vial contains 6 mg
  • J2777 is reported with 1 unit per 0.1 mg
  • Full single-dose vial (6 mg) is injected into patient with zero waste
  • Report J2777-JZ x 60 units

These single-dose billing policies were created for Medicare. Some commercial payers may reimburse for discarded drugs and biologicals from single-use vials/packages as well. Check your payer policies for more information concerning billing rules and any reimbursement.