Does BCBS require modifier JZ?
Asked by: Joy Rogahn | Last update: July 20, 2025Score: 4.5/5 (4 votes)
What J codes require a Jz modifier?
Effective July 1, 2023, modifiers JW and JZ are required for all claims that bill for single-dose container drugs (single-dose vials or single-use packages) payable separately under Medicare Part B; this includes some pharmaceuticals and contrast agents used in medical imaging.
Is a JZ modifier required for commercial insurance?
Effective 7/1/23, use of the JZ modifier is required on all claims for single use vials/packages where there are no discarded amounts. The modifier should only be used for claims that bill for single use vials or packages.
What is the difference between modifier JW and JZ?
1, CMS required the use of JW and JZ modifiers for all claims for drugs from single-use vials or single-use packages payable separately under Medicare Part B. The JW modifier is used to identify any discarded amounts. The JZ modifier is used to attest that there were no discarded amounts.
Does Medicaid require a jz modifier?
Effective July 1, The Centers for Medicare & Medicaid Services (CMS) will now require Modifier JZ appended to HCPCS that are single-use vials that have ZERO waste. CMS began allowing the use of the modifier on January 1, 2023.
Modifiers JZ and JW Discarded Drugs
What is the modifier JZ for BCBS NC?
Effective November 1, 2024, Blue Cross and Blue Shield of North Carolina (Blue Cross NC) is implementing a revision to the reimbursement policy Drugs and Biologicals. Consistent with CMS , Modifier JZ will now be required for a single-use vial or package when there is no discarded/wasted drug or biological.
Does J0897 need a JZ modifier?
Medicare views this as '0mg' of waste, so the JZ modifier is appropriate in this scenario,” she said. It's important to remember that “even those drugs that are 'flat dose' and never produce waste (such as J0897, Denosumab) would require the JZ modifier,” said Ellis.
Is modifier jz for Medicare only?
Modifier JZ
Effective July 1, 2023, providers and suppliers are required to report the JZ modifier on all claims that bill for drugs separately payable under Medicare Part B when there are no discarded amounts from single-dose containers or single-use packages.
Does UHC require a JZ modifier?
The modifier should only be used for claims that bill for single-dose container drugs. Effective with date of service October 1, 2023, UnitedHealthcare Medicare Advantage will align with the CMS requirement for reporting of new modifier JZ to indicate “no waste”.
What is the modifier JZ for Aetna?
Appropriate Use of Modifier JZ (Zero drug amount discarded/not administered to any patient) According to our policy which is based on CMS policy, modifier JZ is a HCPCS Level II modifier that is used to attest that no amount of drug/biological reported on the claim was discarded and eligible for payment.
What is the modifier 95 for BCBS?
Modifier 95: Synchronous telemedicine services rendered via real-time interactive audio and video telecommunications system.
What modifier is not accepted by Medicare?
GZ - Service is not covered by Medicare
The GZ modifier identifies that 1) an item or service is expected to be denied as not reasonable and necessary, and 2) no advance notice of non-coverage was supplied to the member.
When to use jg modifier?
- Modifier JG indicates drug or biological was acquired with 340B drug pricing program discount.
- Modifier TB indicates drug or biological was acquired with 340B drug pricing program discount and is reported for informational purposes.
Does Humana require a JZ modifier?
Humana plans to implement new claims payment procedures to improve processing of claims submitted with modifiers JW and JZ. Providers will be required to report the JW modifier and the JZ modifier in all outpatient settings.
What are J-codes used to bill insurance carriers for?
J-codes, part of HCPCS Level II, are alpha-numeric codes designed for non-oral medications. These medications include a variety of treatments, such as chemotherapy, inhalation products, and immunosuppressant drugs.
When to use modifier kx?
Use of the KX modifier indicates that the supplier has ensured coverage criteria for the DMEPOS billed is met and that documentation does exist to support the medical necessity of item.
What codes require a jz modifier?
Effective 7/1/2023 physicians are required to use JW and JZ modifiers on all claims for single-dose containers, vials, and packages. REMINDER: EFFECTIVE 10/1/2023—Claims missing the JZ/ JW modifier may be returned as unprocessable until claims are properly resubmitted.
What is the HO modifier for BCBS?
The HO modifier signifies that the provider has a master's level degree and should only ever be billed if the provider has the appropriate degree level. Similarly, HN indicates a bachelor's degree level and a HP indicates a doctoral degree level.
Does Medicaid accept a jz modifier?
The Centers for Medicare and Medicaid Services (CMS) will enforce use of the JW modifier or JZ modifier for all claims for drugs from single-use vials or single-use packages payable separately under Medicare Part B beginning Oct. 1.
What is the jz modifier for BCBS?
JZ Modifier: A HCPCS Level II modifier reported on a claim to attest that no amount of drug was discarded and is eligible for payment. The modifier should only be used for claims that bill for single- dose container drugs.
What is the JZ modifier for United Healthcare?
We codified use of the JW modifier to show discarded amounts of drugs from refundable single-dose containers or single-use packages. The final rule also established a requirement that you report the new JZ modifier (Zero drug amount discarded/not administered to any patient) when there's no discarded amounts.
What modifier must always be applied to Medicare claims?
Rationale: Medicare requires that the QW modifier be applied for all claims for payment of test performed in a site with a CLIA waived certificate. If the location does not have a certificate, the service should not be billed and it should not be performed.
What injections need a jz modifier?
The –JW and –JZ modifiers are required for single-dose containers, vials, and packages based on the FDA-approved labeling. It is important to confirm if the drug is considered a single dose by reviewing the vial or package labeling.
Does Aetna require modifier jz?
According to our policy which is based on CMS policy, modifier JZ is a HCPCS Level II modifier that is used to attest that no amount of drug/biological reported on the claim was discarded and eligible for payment. The modifier should only be used for claims that bill for single dose container drugs.
How to bill J0897 to Medicare?
When submitting the claim, remember to: Bill 60 units of J0897 with administration HCPCS 96372 (Therapeutic prophylactic, or diagnostic injection [specify substance or drug]; subcutaneous or intramuscular). J0897 is for 1 mL. Prolia is administered in a single-dose prefilled syringe of 60mg/mL.