Reminder: For Drug Wastage Claims, Use Modifiers JW and JZ — It’s Required!

Highmark follows industry standards — consistent with the Centers for Medicare and Medicaid Services (CMS) approach — requiring the use of the drug wastage modifiers JW and JZ.

These two drug wastage modifiers should be present on all applicable claims, as indicated below: 

• JW – Drug / biological amount discarded / not administered to any patient.
• JZ – Zero drug amount discarded / not administered to any patient.

Prior Communication

We previously communicated this coding requirement on Jan. 1, 2023, when the Reimbursement Policy (RP)-003 Convenience Kits, Drug and Biological Wastage was updated, and again on June 28, 2024, when the following Special Bulletin was published: Highmark Will Implement a Prepayment  Edit for Required Use of Drug Wastage Modifiers: JW And JZ.

Avoid Having Your Claims Rejected – Use the Correct Modifiers

Since July 28, 2024, Highmark has enforced this requirement through a pre-payment edit.

If the appropriate modifier is not present, the claim will reject indicating the code wasn’t submitted with the required modifier. Avoid this scenario by including the correct modifiers.

Additional Resources

• Visit the Claims page here on the Provider Resource Center.