CurrentPremera BluecrossPolicy N/A

Modifier JW and JZ — Reporting wasted and fully administered single‑use vials/packages

Defines when Premera recognizes HCPCS modifiers JW (drug amount discarded/wasted) and JZ (zero drug amount discarded) for single‑use vials/packages, with billing, documentation, and NDC submission requirements for providers and suppliers.

Policy Summary

PayerPremera Bluecross

PolicyModifier JW and JZ — Reporting wasted and fully administered single‑use vials/packages

Policy CodePolicy N/A

Change TypeAdded JZ guidanceclarified JW rulessupplier billing guidance added

Effective DateN/A

Next Review DateNov 12, 2024

Key ActionWhen partial wastage occurs submit two claim lines (administered portion and wasted portion with JW); when no wastage submit a single claim line with JZ and include NDC, quantity, and basis.

SourceLink

POLICY UPDATE CHANGES

Created a new section 'Suppliers of Drugs' describing billing for suppliers/dispensers who do not administer drugs.

Introduced Modifier JZ and guidance for reporting zero drug amount discarded when entire single‑use vial/package is administered.

Clarified JW use restrictions to single‑use vials/packages and documentation and NDC submission requirements for both administered and wasted portions.

Removed prior language that reduced reimbursement for waste to match the dose of the smallest available vial.

2required claim lines when partial wastage occurs (administered + wasted)

1required claim line when no wastage (use modifier JZ)

single‑use only

Policy Summary

PayerPremera Bluecross

PolicyModifier JW and JZ — Reporting wasted and fully administered single‑use vials/packages

Policy CodePolicy N/A

Change TypeAdded JZ guidanceclarified JW rulessupplier billing guidance added

Effective DateN/A

Next Review DateNov 12, 2024

SourceLink

On This Page

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.

modifier applicability (JW/JZ not valid for multi‑dose vials)

NDC requiredNDC number, quantity, and basis required on claims

Coverage Criteria for JW and JZ

Coverage criteria for JW/JZ billing

Reimbursement is allowed only under the following conditions for single‑use vials/packages:

Modifiers JW and JZ apply only to drugs billed with HCPCS codes from single‑use vials or single‑use packages; they are not appropriate for multi‑dose vials.

Policy: Modifier applicability limited to single‑use vials/packages.

ALL of the following

Each claim line must include the applicable NDC number, NDC unit quantity, and basis of measurement (e.g., mg, mL).
Fractional units for administered or wasted drug are not valid and will not be accepted; the combined billed units must equal the total units in the single‑use vial/package.

If the entire single‑use vial/package was administered with no wastage, submit a single claim line with the HCPCS code appended with modifier JZ and include the NDC number, total quantity administered, and basis of measurement; documentation must confirm no wastage.

Use JZ only when no portion was discarded.

children":[],"note":"NOC codes require same modifier reporting when applicable."}

If an infusion is partially administered and terminated due to an adverse reaction, bill the entire single‑dose vial as wasted by appending modifier JW, include an appropriate adverse effect diagnosis code, and document that the infusion was terminated shortly after start in the medical record. This does not apply to multi‑dose vials.

Adverse reaction billing requirements.

Suppliers who only dispense (do not prepare or administer) drugs must bill a single line with modifier JZ for the total units supplied. If the supplier prepared the drug and waste occurred, bill administered and wasted portions per the standard rules above.

Supplier/dispensing billing guidance.

Units billed should correspond to the smallest commercially available vial size that could provide the appropriate dose to minimize waste; when a larger vial is used, excessive volumes of waste will not be reimbursed.

Reimbursement limited to reasonable vial sizes to minimize waste.

Coding and Billing Codes

HCPCS drug codes and NOC examplesCPT

J3490, J3590, C9399 (examples of NOC codes)

When used, JW or JZ must be reported on NOC HCPCS codes administered from single‑dose vials/packages.

Modifier JW — wasted/discarded drug portionHCPCSCovered

JW	Append to HCPCS drug code to report the discarded/wasted portion of a single‑use vial or single‑use package; report number of units wasted and include NDC, NDC unit quantity, and basis of measurement.

Modifier JZ — zero drug amount discardedHCPCSCovered

JZ	Append to HCPCS drug code when entire single‑use vial or single‑use package was administered with no wastage; report total units supplied and include NDC, NDC unit quantity, and basis of measurement.

Fractional unit billing

Policy statementFractional units for administered or wasted drug are not valid and will not be accepted.

Combined units requirementThe combined total of billed units for administered and wasted portions must equal the total number of units in the single‑use vial or package.

Smallest vial guidanceUnits billed should correspond to the smallest commercially available vial that could provide the appropriate dose to minimize or eliminate wastage; excessive waste from larger vials will not be reimbursed.

NDC reporting requirementWhen billing with a drug HCPCS code, the NDC number, NDC unit quantity, and basis of measurement must be submitted for administered and wasted portions.

Provider Billing Actions and Supplier Guidance

Billing Rule

Claim submission actions for JW and JZ

To bill discarded or wasted amounts from single-use vials or packages, append modifier JW to the HCPCS drug procedure code for the portion discarded/not administered. To report that an entire single-use vial/package was administered with zero waste, append modifier JZ to the HCPCS drug procedure code.

Applies only to single-use vials or packages; multi-use vials and excessive-volume single-use vials are not eligible for wasted-drug reimbursement.
JW = Drug amount discarded/not administered to any patient — append to HCPCS code when partial waste occurred.
JZ = Zero drug amount discarded/not administered to any patient — append to HCPCS code when entire vial/package administered with no waste.

Documentation Required

Modifier Definitions

Modifier JW — definition & applicability

DefinitionModifier JW represents the discarded/wasted/non‑administered portion of a drug HCPCS procedure code.

ApplicabilityValid ONLY when appended to a drug HCPCS procedure code for a single‑use vial or single‑use package; not appropriate for multi‑dose vials.

Claim linesWhen waste occurs, bill two claim lines: one for the administered portion (HCPCS code with no modifier) and one for the wasted portion (same HCPCS code + JW).

DocumentationMedical record must document the discarded portion and the portion administered to the member.

Modifier JZ — definition & applicability

DefinitionModifier JZ indicates that no amount of a single‑use drug or single‑use package was discarded or wasted and that the entire drug was administered.

Adverse reaction billing

If a patient has an adverse reaction after partial administration of a prepared single-dose vial or single-use drug package, bill the entire single-dose vial/package as wasted by appending modifier JW and billing all units for that vial/package. Include an appropriate adverse effect diagnosis code for the specific drug to support the claim. The associated NDC number, NDC unit quantity and basis of measurement must be submitted with the HCPCS code. The patient’s medical record must document the adverse reaction and that the infusion was terminated shortly after it was started. This does not apply to multi-dose vials or packages.

Use an appropriate ICD-10 adverse effect diagnosis code for the specific drug (see Table of Drugs and Chemicals in ICD-10-CM).
If NO portion of the infusion was administered, do not bill with modifier JW to represent wastage.
Document number of units prepared, units administered (if known), and units billed as wasted in the medical record.

Billing Rule

Supplier/dispensing billing

When a supplier or pharmacy only dispenses or supplies a drug and does not administer it or participate in preparation, bill the single-dose vial on one line with the HCPCS drug procedure code appended with modifier JZ and report the total number of units supplied/dispensed. If the supplier participated in preparation (including discarding amounts prior to supply), bill according to the administered/wasted split rules (multiple lines with JW for wasted units and no modifier for administered units).

Supplier-only (no preparation/administration): single line, HCPCS + JZ, total units supplied.
If supplier prepared the drug prior to dispensing and amounts were discarded before supply, use separate lines to bill administered and wasted portions (JW for wasted units).
Include NDC number, NDC unit quantity, and NDC basis of measurement as required when billing HCPCS drug codes.

ApplicabilityValid ONLY when appended to a drug HCPCS procedure code for a single‑use vial or single‑use package; not appropriate for multi‑dose vials.

Claim line when no wastageSubmit a single claim line with the HCPCS code + JZ, include number of units, NDC number, NDC unit quantity, and basis of measurement; documentation must confirm no wastage.