JZ Modifier Use With Skin Substitutes

CMS has issued guidance¹ requiring the use of Modifier JW on all claims for biologicals from single-dose containers that are separately payable under Medicare Part B when there are unused / discarded amounts. CMS has also issued guidance1 requiring the use of Modifier JZ on all claims for biologicals from single-dose containers that are separately payable under Medicare Part B when there are no unused / discarded amounts.

When no biological is discarded, the code for the product should be listed on the claim form, with all units and a JZ Modifier. When there is discarded biological product, the code for the product should be listed on the claim form twice, one line representing the number of units used and the second line representing the number of units discarded with a JW Modifier appended.

There are two exceptions to this guidance:

The NGS Part B MAC states that “skin substitutes are excluded from the requirement to use the JZ modifier and will cause rejections when appended.” NGS goes on to state, “only the JW modifier should be used to report drug wastage for skin substitutes.²”  The NGS Part B MAC jurisdiction includes ME, NH, VT, MA, RI, CT, NY, MN, WI, and IL.

The CGS Part B MAC has issued guidance to multiple stakeholders to not use the JZ / JW modifiers with skin substitutes. There is no public link where this is listed. However, the new Novitas, First Coast, and CGS skin substitute policies that take effect 9-17-23, are identical with one exception:  Novitas and First Coast provide direction regarding use of JZ / JW Modifiers and CGS does not.

References:

¹ Medicare Program Discarded Drugs and Biologicals – JW Modifier and JZ Modifier Policy Frequently Asked Questions

² Drugs and Biologicals – Coverage and Billing