July 26, 2024
We routinely review our coverage, reimbursement, and administrative policies for potential updates. In that review, we take into consideration one or more of the following: evidence-based medicine, professional society recommendations, Centers for Medicare & Medicaid Services (CMS) guidance, industry standards, and our other existing policies.
As a result of a recent review, effective July 28, we will administratively deny a drug supplied in only single-dose formulation when billed without either modifier JW or modifier JZ, and another claim line for the same drug on the same date of service with modifier JW or JZ does not exist.
This update aligns with the Discarded Drugs and Biologicals – JW Modifier and JZ Modifier Policy set by CMS. Additional information is available in the Discarded Drugs and Biologicals – JW Modifier and JZ Modifier Policy Frequently Asked Questions.
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