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).