CurrentmedstarfamilychoicedistrictofcolumbiaPolicy N/A

Modifier JW (Discarded Drug) and Modifier JZ (No Discard) Reporting

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Defines MedStar Family Choice District of Columbia requirements for reporting HCPCS modifiers JW and JZ on professional and ambulatory surgical center claims for separately payable drugs from single-dose containers or single-use packages, effective for claims received on or after July 28, 2026.

Policy Summary

Payermedstarfamilychoicedistrictofcolumbia

PolicyModifier JW (Discarded Drug) and Modifier JZ (No Discard) Reporting

Policy CodePolicy N/A

Change TypeAdded prospective prepayment edits

Effective DateJul 28, 2026

Next Review DateN/A

Key ActionAppend modifier JW to separate line for discarded drug amounts and JZ when no amount is discarded; expect prepayment reviews for correct modifier use.

SourceLink

POLICY UPDATE CHANGES

MedStar Family Choice requires correct utilization of HCPCS modifiers JW and JZ for separately payable drugs from single-dose containers or single-use packages for claims received on or after July 28, 2026.

Jul 28, 2026effective date for claims received on or after

Professional & ASCapplies to provider types

2modifiers addressed

Modifier JW/JZ Billing Criteria

Modifier JW/JZ billing criteria

Billing requirements effective for claims received on or after July 28, 2026:

Apply these requirements to professional claims and ambulatory surgical center claims for separately payable drugs from single-dose containers or single-use packages.

Use modifier JW (Discarded Drug) when a portion of a separately payable drug from a single-dose container or single-use package is discarded.

When JW applies, bill the administered amount on one claim line and bill the discarded amount on a separate claim line with modifier JW appended; JW applies only to the discarded amount, not the administered amount.

When more than one vial with different NDCs is used, report each NDC on a separate claim line with appropriate units administered, and include an additional line indicating discarded units with modifier JW.

Use modifier JZ (No Discard) when no amount of a separately payable drug from a single-dose container or single-use package is discarded; bill the full administered amount on a single line with modifier JZ appended.

Claims will be subject to prospective (prepayment) reviews and edits to verify correct reporting of JW and JZ modifiers in partnership with AMPS and aligned to DHCF and CMS guidance.

HCPCS Modifiers and Line Reporting

HCPCS modifiers for discarded/no-discard drug reportingModifierCovered

JW	Modifier used to report the amount of a separately payable drug discarded from a single-dose container or single-use package. The amount administered is billed on one line and the discarded amount is billed on a separate claim line with modifier JW appended.
JZ	Modifier used to report that no amount of a separately payable drug from a single-dose container or single-use package was discarded. When JZ applies, bill the full administered amount on a single line with modifier JZ appended.

Separate line reporting for discarded amount

Billing formatDiscarded drug amount must be billed on a separate claim line with modifier JW; the administered amount must be billed on a separate line.

Multiple NDCsWhen more than one vial with different NDCs is used, report each NDC on a separate claim line with appropriate units administered and add an additional line for discarded units with modifier JW.

Modifier scopeJW applies only to the amount of drug discarded and not to the amount administered.

JZ single-line reporting

Single-line billing when no discardWhen no amount is discarded, bill the full administered amount on a single claim line with modifier JZ appended.

Modifier applicationJZ is used for a separately payable drug from a single-dose container or single-use package when no amount is discarded.

Contact for questionsFor questions, contact MedStar Family Choice DC Provider Customer Service at 800-261-3371 or mfcdc-providerrelations@medstar.net.

Prepayment Review and Operational Impacts

Prior Authorization

Prepayment review for JW/JZ modifier reporting

Prospective (prepayment) reviews will include edits to verify correct reporting of JW and JZ modifiers as part of MFC-DC’s partnership with AMPS and aligned to DHCF and CMS guidance.

Modifier Definitions

Modifier JW (Discarded Drug)

DefinitionModifier JW is appended to a claim line indicating the amount of a separately payable drug discarded from a single-dose container or single-use package.

Billing requirementThe administered amount should be billed on one line and the discarded amount billed on a separate claim line with JW appended.

Multiple-vial guidanceIf multiple vials with different NDCs are used, report each NDC on a separate line with units administered and add a separate line for discarded units with JW.

Modifier JZ (No Discard)

DefinitionModifier JZ is appended to a claim line when no amount of a separately payable drug from a single-dose container or single-use package is discarded.

Billing requirementWhen JZ applies, bill the full administered amount on a single line with modifier JZ appended.

Use caseApplies to separately payable drugs from single-dose containers or single-use packages where nothing is discarded.

Policy Summary

Payermedstarfamilychoicedistrictofcolumbia

PolicyModifier JW (Discarded Drug) and Modifier JZ (No Discard) Reporting

Policy CodePolicy N/A

Change TypeAdded prospective prepayment edits

Effective DateJul 28, 2026

Next Review DateN/A

Key ActionAppend modifier JW to separate line for discarded drug amounts and JZ when no amount is discarded; expect prepayment reviews for correct modifier use.

SourceLink

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Modifier JW (Discarded Drug) and Modifier JZ (No Discard) Reporting

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Modifier JW/JZ Billing Criteria

Modifier JW/JZ billing criteria

Billing requirements effective for claims received on or after July 28, 2026:

Apply these requirements to professional claims and ambulatory surgical center claims for separately payable drugs from single-dose containers or single-use packages.

Use modifier JW (Discarded Drug) when a portion of a separately payable drug from a single-dose container or single-use package is discarded.

Claims will be subject to prospective (prepayment) reviews and edits to verify correct reporting of JW and JZ modifiers in partnership with AMPS and aligned to DHCF and CMS guidance.

HCPCS Modifiers and Line Reporting

HCPCS modifiers for discarded/no-discard drug reportingModifierCovered

JW	Modifier used to report the amount of a separately payable drug discarded from a single-dose container or single-use package. The amount administered is billed on one line and the discarded amount is billed on a separate claim line with modifier JW appended.
JZ	Modifier used to report that no amount of a separately payable drug from a single-dose container or single-use package was discarded. When JZ applies, bill the full administered amount on a single line with modifier JZ appended.

Separate line reporting for discarded amount

Billing formatDiscarded drug amount must be billed on a separate claim line with modifier JW; the administered amount must be billed on a separate line.

Modifier scopeJW applies only to the amount of drug discarded and not to the amount administered.

JZ single-line reporting

Single-line billing when no discardWhen no amount is discarded, bill the full administered amount on a single claim line with modifier JZ appended.

Modifier applicationJZ is used for a separately payable drug from a single-dose container or single-use package when no amount is discarded.

Contact for questionsFor questions, contact MedStar Family Choice DC Provider Customer Service at 800-261-3371 or mfcdc-providerrelations@medstar.net.

Modifier Definitions

Modifier JW (Discarded Drug)

DefinitionModifier JW is appended to a claim line indicating the amount of a separately payable drug discarded from a single-dose container or single-use package.

Billing requirementThe administered amount should be billed on one line and the discarded amount billed on a separate claim line with JW appended.

Multiple-vial guidanceIf multiple vials with different NDCs are used, report each NDC on a separate line with units administered and add a separate line for discarded units with JW.

Modifier JZ (No Discard)

DefinitionModifier JZ is appended to a claim line when no amount of a separately payable drug from a single-dose container or single-use package is discarded.

Billing requirementWhen JZ applies, bill the full administered amount on a single line with modifier JZ appended.

Use caseApplies to separately payable drugs from single-dose containers or single-use packages where nothing is discarded.