Centers for Medicare & Medicaid Services (CMS) Coding Update

Effective July 1, 2023, CMS requires the use of a modifier in “buy & bill” medical claims submitted to your Medicare MAC for all single-dose or single-use drug syringes or vials that are separately payable under Medicare Part B to track unused/discarded product. Based on currently available information, this requirement applies to intra-articular HA products.

Either the JZ modifier (to attest that there was no discarded amount from a single-use product)or the JW modifier (to report the amount that is discarded from a single-use product) is now required. The rule is effective now. Claims after July 1, 2023 without the JZ or JW modifier may be subject to an audit. Starting October 1, 2023, claims for drugs from single-dose containers that do not use the modifiers as appropriate may be returned as un-processable until claims are properly submitted.

?These rules will apply to your administration of Hyaluronic Acid and their associated J Code.

This requirement is not applicable for commercial patients or Medicare Advantage insured patients, unless specifically indicated by the patient’s plan.

For more information, please review the Q&A document published by CMS here.

For explanation on filing your HCFA, please review the Q&A document published by First Coast here.

For Frequently Asked Questions, please review the FAQ document published by CMS here.

IPS HA Ordering Information

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