CurrentBlue Cross Blue Shield - IllinoisPolicy CPCP017

Wasted/Discarded Drugs and Biologicals Policy

Defines billing, coding, and reimbursement practices for discarded or wasted drugs and biologicals (use of JW/JZ modifiers) for Blue Cross and Blue Shield of Illinois; applies to providers, suppliers, and facilities submitting claims for non-inpatient services under BCBSIL plans.

Policy Summary

PayerBlue Cross Blue Shield - Illinois

PolicyWasted/Discarded Drugs and Biologicals Policy

Policy CodePolicy CPCP017

Change TypeClarifications and additions (non-material)

Effective DateNov 25, 2025

Next Review DateN/A

Key ActionAppend JW on a separate line for discarded amounts from single-use vials for non-inpatient places of service and include required documentation.

SourceLink

POLICY UPDATE CHANGES

JZ Modifier Usage section updated with new language and guidance.

New 'Suppliers - Modifier Usage' section added clarifying JW and JZ use for suppliers who do not administer drugs.

New examples of non-reimbursable situations added under 'When Drugs and Biologicals are not Eligible for Reimbursement'.

JW/JZmodifier guidance for discarded drug reporting

Separate linewasted amount billed separately with JW

NDC requiredNDC submission required for NDC reimbursement

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Non-inpatientJW applicable to non-inpatient settings

Reimbursement Eligibility

Reimbursement Eligibility Criteria

Eligible reimbursement requires specific documentation and billing practices for discarded single-use drug amounts.

ALL of the following

The dose administered, discarded amount, exact date and time of administration, and the reason for wastage are clearly and acceptably documented in the medical record.
The discarded amount is billed on a separate line than the administered amount with the correct CPT/HCPCS code, units, and JW modifier for all non‑inpatient places of service.
The discarded drugs or biologicals are not administered to another member/patient.
The drug or biological administered is only available in a single‑use vial or single‑use package.
The drug or biological is administered to the member appropriately for the member's medical condition and the unused portion is discarded (not billed as overfill).
Units billed correspond with the smallest dose or vial available for purchase from the manufacturer that provides the appropriate dosage for the member.
Total dose (administered + wasted) must not exceed the vial/package amount; if amount administered is not a multiple of the CPT/HCPCS unit, round to the next highest unit per the CPT/HCPCS description.
When billing for NDC‑based reimbursement, include the NDC with the CPT/HCPCS code and ensure NDC units correspond to the CPT/HCPCS units billed (e.g., milliliter, gram, units of use).

Not eligible for JW

Discarded amounts from multi‑use vials/packages (JW is not appropriate).
Overfill or pooled overfill from single‑use containers may not be billed.

Special/conditional scenarios (may be eligible or not depending on documentation)

Whole vial/package waste due to manufacturer defect, shipping damage, improper storage, or provider administration error (may not be reimbursed without plan discretion).
Events such as member death/hospitalization after shipment for home delivery, replacement after disaster, or theft from member (eligibility determined case‑by‑case).

Modifiers, Codes, and Billing Units

ModifiersModifier

JW	Modifier indicating drug amount discarded/not administered
JZ	Modifier indicating no discarded amounts from single-use vials/packages

Example HCPCS CodesHCPCS

J9312	Rituximab 10mg (example billing units and wastage lines)
J9355	Trastuzumab 10mg (example billing units and wastage lines)

Unit rounding rule

Rounding ruleIf the amount administered is not a multiple of the CPT/HCPCS code unit, round to the next highest unit in the CPT/HCPCS description.

Total dose constraintThe total dose (administered plus wasted) must not exceed the vial or package amount.

Billing units requirementUnits of service must be billed in multiples of the dosage specified in the full CPT/HCPCS description.

NDC linkage

NDC inclusionNDC codes must be included with the CPT/HCPCS code when billing for drugs to receive NDC‑based reimbursement.

NDC unit correspondenceThe NDC units billed should correspond to the CPT/HCPCS units billed to reflect the numeric quantity and units of measure (e.g., mL, gram, units of use).

Claims, Documentation, and Supplier Responsibilities

Documentation Required

Documentation and Claim Submission Requirements

Providers are responsible for submission of accurate documentation of services performed. Providers must submit claims using valid code combinations from HIPAA-approved code sets and follow industry-standard coding guidelines (e.g., Uniform Billing Editor, AMA CPT, HCPCS, ICD-10-CM/PCS, NDCs, DRG guidelines, CMS National Correct Coding Initiative and related CCI edits). Claims are subject to code edit protocols and may be reviewed for benefit coverage, provider contract language, medical policies, clinical payment and coding policies, and coding software logic. The Plan reserves the right to request supporting documentation; upon request providers should submit additional documentation, including medical records documenting drug product preparation for claims with wasted or discarded drugs/biologicals. Claim submissions that do not adhere to coding and billing policies may delay or impact processing and reimbursement.

Bill units in multiples of the dosage specified in the CPT/HCPCS description; if the administered amount is not a multiple, round to the next highest unit.
Total dose (administered plus wasted) must not exceed the vial or package amount.
When billing discarded amounts, report the actual dosages with the correct CPT/HCPCS code and correct units of service.
For discarded drugs/biologicals from single‑use vials or packages, bill the discarded amount on a separate line with the JW modifier for all non‑inpatient places of service.
The JW modifier should be applied only to the amount discarded; document discarded amounts in the member's medical record.

Key Terms

Drug Waste

DefinitionDrug Waste: The partial vial, package, or product of drug or biologic that is discarded and not administered to any member.

ScopeIncludes any portion of a drug or biologic that is not given to a patient and is disposed of rather than reused.

Relation to billingDiscarded drug waste may be eligible for reimbursement only when billed and documented per policy (e.g., JW modifier rules).

JW Modifier

DefinitionJW Modifier: Indicates the amount of drug or biological that was discarded and not administered to any member.

Billing useWhen used for discarded amounts, the discarded amount must be billed on a separate line with the correct CPT/HCPCS code, units, and JW modifier for non‑inpatient places of service.

Policy Summary

PayerBlue Cross Blue Shield - Illinois

PolicyWasted/Discarded Drugs and Biologicals Policy

Policy CodePolicy CPCP017

Change TypeClarifications and additions (non-material)

Effective DateNov 25, 2025

Next Review DateN/A

Key ActionAppend JW on a separate line for discarded amounts from single-use vials for non-inpatient places of service and include required documentation.

SourceLink

On This Page

Purpose of NDC linkageNDCs identify drugs using a unique three‑segment product identifier to support NDC‑based reimbursement determinations.

The Plan may reimburse the discarded amount of a single‑use dosage drug/biological and the amount administered to the member up to the vial/package label amount as necessary for the member's condition.

Billing Rule

Supplier Modifier Usage

Suppliers who prepare but do not administer drugs must use modifiers to indicate whether any drug was discarded during preparation. Documentation of amounts prepared and discarded must be maintained in the member's medical record and made available upon request.

Append modifier JW when amounts are discarded during preparation for suppliers that do not administer the drug.
Append modifier JZ when no amount of drug is discarded during the preparation process prior to supplying the drug to the patient.

Supplier guidanceSuppliers preparing but not administering drugs should append JW if amounts are discarded during preparation.

JZ Modifier

DefinitionJZ Modifier: Indicates no discarded amounts from single‑use vials or single‑use packages.

Supplier guidanceSuppliers preparing but not administering drugs should append JZ when no amounts are discarded during preparation.

Contrast to JWUsed to report that no portion of a single‑use vial/package was discarded, opposite of JW which reports discarded amounts.

Multi‑use vials/packages

DefinitionMulti‑use vials/packages: Drug or biologic packages that allow more than one dose to be withdrawn for administration by injection or infusion.

Modifier noteUse of modifier JW is not appropriate for drugs that are from multiple‑dose vials or packages.

Reimbursement implicationDiscarded amounts from multi‑dose containers are not billed using JW under this policy.

Single‑use vials/packages

DefinitionSingle‑use vials/packages: Drug or biologic packages that allow only one (1) dose to be withdrawn for administration by injection or infusion.

Reimbursement conditionEligible discarded amounts must come from drugs only available in a single‑use vial or package and meet documentation and billing criteria (e.g., separate line with JW).

Billing restrictionDiscarded amounts from single‑use containers must not be administered to another patient and must be documented in the medical record to be eligible for reimbursement.

Overfill

DefinitionOverfill: Any excess product provided without charge to the provider (overfill) from a vial or package.

Billing prohibitionProviders may not bill for overfill harvested from single‑use containers, including pooled overfill from more than one container, because that overfill does not represent a cost to the provider.

Policy consequenceOverfill and pooled overfill from single‑use containers are non‑billable and will not be reimbursed.