CurrentColorado Rocky Mountain Health PlansPolicy 2026R9001A

Discarded Drugs and Biologicals — CMS 1500 Reimbursement

Reimbursement rules for reporting and billing discarded amounts of drugs and biologicals administered to UnitedHealthcare Medicare Advantage members on CMS 1500 forms; applies to network physicians and other qualified health care professionals furnishing Medicare Advantage services.

Policy Summary

PayerColorado Rocky Mountain Health Plans

PolicyDiscarded Drugs and Biologicals — CMS 1500 Reimbursement

Policy CodePolicy 2026R9001A

Change TypeNo material change

Effective Date

Next Review Date

Key ActionMaintain medical record documentation showing amount administered and amount wasted; make records available upon request.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

single-use vials onlywaste reimbursed for

JZ (Oct 1, 2023)modifier to attest no waste

JW (≥1 unit)modifier for waste

CMS 1500form governed

When Discarded Drug Amounts Are Reimbursed

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Discarded drug reimbursement criteria

Reimbursement is permitted for discarded amounts when specific conditions are met:

ALL of the following

Service billed on a CMS 1500 form for a UnitedHealthcare Medicare Advantage member
Drug or biological was administered from a single-use vial or single-use package (multi-use vials are excluded from payment for discarded amounts)
Medical record documentation clearly indicates the amount administered and the amount wasted; records must be made available upon request
Units billed reflect the HCPCS unit definition and correspond to the smallest purchasable dose (bill in multiples of the HCPCS dosage unit)

Billing for waste: If wastage is billed separately, report the wasted amount on a separate line with modifier -JW and bill at least one billing unit (minimum billable waste unit = one HCPCS billing unit); -JW is not allowed for waste from multi-dose vials

No waste attestation: If no waste occurred for a single‑dose container, report the administered amount with modifier -JZ to attest that no amount was discarded (JZ guidance effective Oct 1, 2023)

ALL of the following

Do not bill the full vial amount split between patients; bill only the amount actually given to each beneficiary
Providers are encouraged to schedule patients to minimize waste where clinically appropriate

HCPCS Codes and Billing Units

sample HCPCS examplesHCPCS

J0585	OnabotulinumtoxinA per unit example referenced
J1756	Example showing unit definition (1 mg)

Minimum billable waste unit for -JW

Minimum billable waste unitWhen reporting discarded amounts with modifier -JW, the amount identified as wasted must be at least equal to one billing unit.

Separate line requiredReport the wasted amount on a separate claim line with the -JW modifier appended to the associated HCPCS code.

Not for multi-dose vialsModifier -JW is not permitted to identify discarded amounts from multi-dose vials (MDVs).

Documentation and Modifier Use Requirements

Documentation Required

Documentation Requirement — Amount Administered and Wasted

Medical record documentation must clearly indicate the amount of drug administered and the amount wasted. Documentation is expected to be maintained in the patient’s medical record and made available to Colorado Rocky Mountain Health Plans upon request. Every page of the record must be legible and include appropriate patient identification (for example, full name and dates of service) and information identifying the clinician responsible for care. The submitted medical record should support the selected diagnosis code(s) and CPT/HCPCS code(s). When a portion of a drug is discarded, the record must show the amount administered and the amount wasted.

Maintain documentation of amount administered and amount wasted in the medical record
Make records available to the payer upon request
Ensure records are legible and include patient identifiers, dates of service, and clinician identification

Billing Rule

Use of JW and JZ Modifiers

Use modifier -JW to report the amount of drug discarded (wasted) on a separate line from the administered amount. Modifier -JW applies only to discarded amounts and the discarded quantity reported with -JW must be at least one billing unit. Do not use -JW for amounts discarded from multi-dose vials (MDVs). Use modifier -JZ to attest that no amount of drug was discarded for single-dose container drugs (per CMS guidance effective July 1, 2023); for the administered amount line include the appropriate HCPCS/CPT code, the JZ modifier, and the number of units in the units field. When billing, units of service must be billed in multiples of the HCPCS descriptor's dosage; roll the administered amount up to the next billing unit and the discarded amount down to the previous billing unit as needed to avoid overpayment.

-JW: Report discarded (wasted) drug amount on a separate line; discarded quantity must be ≥ one billing unit; not permitted for MDV discarded amounts
-JZ: Use to attest no waste for single-dose container drugs; include JZ on the administered line with units
Billing: Bill units in multiples of the HCPCS descriptor dose; roll administered amount up to next bill unit and discarded amount to previous bill unit to prevent overpayment

Modifier Definitions

JW modifier — definition

DefinitionModifier -JW = Drug amount discarded and not administered to any patient.

Use on claim linesAppend -JW to the HCPCS code on a separate line to report only the discarded portion (must meet minimum billing unit rules).

DocumentationMedical record must clearly document the amount administered and the amount wasted to support -JW reporting.

JZ modifier — definition

DefinitionModifier -JZ = Attestation that no amount of drug was discarded (zero drug amount wasted).

ApplicabilityUse JZ only for claims that bill for single‑dose container drugs; UnitedHealthcare MA aligns with CMS reporting effective Oct 1, 2023.

Claim line requirementsInclude the HCPCS/billing code, the JZ modifier, and the number of units administered in the units field on the administered‑amount line.