CurrentColorado Rocky Mountain Health PlansPolicy 2026R6004B

Reimbursement policy for drugs and biologicals billed on CMS-1500 and UB-04 (JW/JZ modifiers)

Governs reimbursement rules for drugs and biologicals billed on CMS-1500 and UB-04 forms (including discarded amounts) for UnitedHealthcare Community Plan Medicaid products; affects all network and non-network providers submitting claims on these forms.

Policy Summary

PayerColorado Rocky Mountain Health Plans

PolicyReimbursement policy for drugs and biologicals billed on CMS-1500 and UB-04 (JW/JZ modifiers)

Policy CodePolicy 2026R6004B

Change TypeAdded requirement

Effective Date

Next Review Date

Key ActionAppend modifier JW on a separate line to report discarded amounts and append modifier JZ on the administered line to attest no discarded amount.

SourceLink

POLICY UPDATE CHANGES

Reimbursement Guidelines: Updated to add JZ modifier requirement.

UB-04 & CMS-1500forms governed

JW requireddiscarded modifier

JZ requiredno-waste modifier

Community Planproduct applicability

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Reimbursement criteria for single-use vial drugs/biologicals

Providers may be reimbursed for administered doses and, when properly reported, for discarded amounts from single-use vials/packages subject to coding and billing rules.

Reimbursement allowed only when documentation supports both the administered amount and the discarded amount in the patient medical record.

ALL of the following

Report the administered drug amount on one claim line using the appropriate CPT/HCPCS code and units billed in multiples of the CPT/HCPCS descriptor (units should correspond with the smallest dose/vial available to minimize wastage).
When no drug is discarded, append modifier JZ to the administered line to attest that no amount of drug was discarded (JZ is required for single‑dose container drugs).

ALL of the following

When drug remainder is discarded from a single‑use vial or single‑use package, report the discarded amount on a separate claim line using the same CPT/HCPCS code with modifier JW appended to identify the discarded units.
JW is only permitted for single‑use vials/packages and must not be appended for multi‑dose vials (MDV).

Multiple NDCs/vials

If multiple vials with different NDCs are used, report each NDC on its own claim line with appropriate administered units from that vial.
Add an additional line for discarded units with modifier JW as applicable; JW lines should reflect the discarded units for the specific NDC/vial.

ALL of the following

Units must be billed in multiples of the dosage specified in the CPT/HCPCS descriptor; if administered amount does not equal a billing unit, roll the administered amount UP to the next billing unit on the administered line.
When reporting discarded units with JW, roll the discarded amount DOWN to the previous billing unit to avoid overpayment.
The JW modifier is not permitted when the actual dose administered is less than the billing unit (billing an additional JW unit in that case would result in overpayment).

Billing Units and Modifiers

Modifiers for single-dose container billingModifierCovered

JW	Identifies discarded amount from single-use vial or package
JZ	Identifies that no amount of drug was discarded (no waste)

inv-03: Billing unit alignment rule — units must align with CPT/HCPCS descriptor; rounding/roll-up rules for administered and discarded amounts

Billing unit alignmentUnits must be billed in multiples of the dosage specified in the full CPT/HCPCS descriptor; billed units should correspond with the smallest purchasable dose that can provide the appropriate patient dose while minimizing wastage.

Rounding rule — administered amountAlways roll the administered amount UP to the next billing unit when the actual administered dose does not equal a full billing unit.

Rounding rule — discarded amountWhen reporting discarded amounts (JW), roll the discarded amount DOWN to the previous billing unit to avoid overpayment.

Prohibition on JW when billed unit > administered doseJW is not permitted when the actual dose administered is less than the billing unit (would cause overpayment); do not bill a separate JW line in that scenario.

ExampleIf code is reportable in 10 mg increments and 77 mg is administered from a 100 mg SDV, report 8 units as administered and 2 units with modifier JW for the discarded amount.

Provider Billing Requirements

Billing Rule

Billing modifiers for discarded/no-waste drugs

When billing for single-dose vial (SDV) or single-use package drugs and biologics, providers must follow CMS guidance for reporting administered and discarded drug amounts. Report the amount administered on one claim line and, if any drug was discarded, report the discarded amount on a separate claim line with modifier JW appended to the associated CPT/HCPCS code. Do not append JW to multi-dose vials (MDV).

JW modifier: Append on a separate line to indicate the amount discarded from a single vial or single-use package. JW is only for discarded amount, not the administered amount.
JZ modifier: Append to the administered line to attest that no amount of drug was discarded (no waste). Use JZ only for single-dose container drugs.
Units billing: Bill units in multiples of the dosage specified in the CPT/HCPCS descriptor. Where possible, choose units that correspond with the smallest commercially available vial to minimize wastage.
Rounding rules to avoid overpayment: Roll the amount administered UP to the next billing unit on the administered line, then roll DOWN to the previous billing unit when reporting discarded units with JW.
Prohibited use of JW: Do not report JW when the actual administered dose is less than the billing unit (that administered line already represents the full billing unit and cannot have an additional JW line for the remainder).
Documentation: The amounts administered and discarded must be documented in the patient’s medical record.
Multiple NDCs: When more than one vial with different NDCs is used, report each NDC and units given on separate lines; then add an additional line indicating discarded units with JW.

Key Definitions

inv-05: Discarded Drug or Biological — definition of discarded amount from single-use/dose vials or packages

Definition — Discarded Drug or BiologicalThe amount of a single use/dose vial or other single use/dose package that remains after administering a dose/quantity of a drug or biological.

Applicable contextApplies to single-use/dose vials or single-dose containers; reimbursement may be made for discarded amounts when properly reported and documented.

Documentation requirementThe amount of drug administered and the discarded drug or biological must be documented in the patient’s medical record.

inv-06: JW and JZ modifiers — definition and intended use of each modifier

JW modifier — purposeIdentifies and is appended to a separate claim line to report the amount of drug discarded from a single vial or single package drug or biological.

JW usage constraintsJW is only permitted for single-use/single-dose vials or packages and is inappropriate for multi-dose vials; JW applies only to the discarded amount, not the administered amount.

JZ modifier — purposeIdentifies and is appended to the administered line to attest that no amount of drug was discarded (‘no waste’) for single-dose container drugs.

JZ requirement and alignmentCMS published guidance requiring JZ to attest no waste; UnitedHealthcare Community Plan aligns with this CMS requirement (note: state exceptions may apply).

Policy Summary

PayerColorado Rocky Mountain Health Plans

PolicyReimbursement policy for drugs and biologicals billed on CMS-1500 and UB-04 (JW/JZ modifiers)

Policy CodePolicy 2026R6004B

Change TypeAdded requirement

Effective Date

Next Review Date

Key ActionAppend modifier JW on a separate line to report discarded amounts and append modifier JZ on the administered line to attest no discarded amount.

SourceLink

On This Page

OpenPayer

Reimbursement policy for drugs and biologicals billed on CMS-1500 and UB-04 (JW/JZ modifiers)

Reimbursement Criteria

Billing Units and Modifiers

Provider Billing Requirements

Key Definitions