Billing for Wasted and Administered Drugs

We announced new drug and biologic edits in the February 2024 Provider News. Unfortunately, claim submissions for wasted and administered drugs from a single-use vial or package continue to be coded incorrectly when using the following modifiers:

• Modifier JW – Drug amount discarded
• Modifier JZ – Zero drug amount discarded

As a result, multiple claims are being denied reimbursement due to incorrect coding. To correctly code for drug waste and for a drug that was fully administered from a single-use vial or package, follow these instructions:

To submit a claim for wasted drugs, submit two separate claim lines:

Claim line #1:

• HCPCS code for drug portion administered appended without modifier
• Number of HCPCS units given to the patient
• NDC number, NDC unit quantity and NDC basis of measurement for drug administered (see the National Drug Code (NDC) Billing Guidelines-Professional Claims Payment Policy)
• Billed amount

 Claim line #2:

• The same HCPCS code for the portion of the drug wasted appended with modifier JW
• Number of HCPCS units wasted
• NDC number, NDC unit quantity and NDC basis of measurement for drug amount wasted (see the National Drug Code (NDC) Billing Guidelines-Professional Claims Payment Policy)
• Billed amount

Documentation in the patient’s medical record must clearly indicate the number of units administered and the number of units discarded.

To submit a claim for a totally administered drug without waste, submit a single claim line:

• HCPCS code for drug administered in full appended with modifier JZ
• Number of HCPCS units administered to the patient
• NDC number, NDC unit quantity and NDC basis of measurement for drug fully administered (see the National Drug Code (NDC) Billing Guidelines Professional Claims Payment Policy)
• Billed amount

Documentation in the patient’s medical record must indicate that the total number of units in the single use vial were fully administered with no waste.

Modifiers JW and JZ are not appropriate to be billed with multi-dose drug vials. Appending these modifiers to a multi-use drug vial procedure code will result in a denial of reimbursement.

For more details, review the payment policies for Modifier JW and JZ (cmi_171624) as well as for NDC Drug Code billing (cmi_171628) in Availity.