In the 2023 Centers for Medicare & Medicaid Services (CMS) Physician Fee Schedule Final Rule, CMS confirmed the implementation of the new JZ Modifier. The JZ Modifier became available to use as of January 1, 2023, and is required to be implemented no later than July 1, 2023.
The JZ Modifier indicates that from a single-dose container, there was zero drug amount discarded/not administered to patient. Providers must use the JZ Modifier for drugs that are separately payable under Medicare Part B.
Under the Medicare Physician Fee Schedule, contrast agents are separately paid. This means that in this payment system, it is required to use the JZ Modifier for single-dose contrast agents.
However, please note: under the Hospital Outpatient Prospective Payment System (HOPPS), contrast agents are bundled and not separately payable. This means that the JZ Modifier is not required for contrast agents.
Also, claims that do not properly report modifiers on or after October 1, 2023 may be returned as unprocessable until claims are revised and resubmitted.
Interestingly, the JZ Modifier comes six years after CMS first introduced the JW Modifier, which indicates the drug amount that is discarded/not administered to any patient. Like the JZ Modifier, the JW Modifier is required when drugs are separately payable.
For more information, please visit www.cms.gov/medicare/medicare-fee-for-service-payment/hospitaloutpatientpps/downloads/jw-modifier-faqs.pdf
You may also contact the Bracco Reimbursement Hotline for any questions. Please email askbracco@reimbursement.bracco.com or call 1-800-349-1388.