Maryland Medicaid: Discarded drugs and biologicals reimbursement policy update

Starting May 1, 2025, UnitedHealthcare Community Plan of Maryland will recognize modifier JZ on professional claims in alignment with the Centers from Medicare and Medicaid (CMS) guidelines. The JW modifier will continue to be recognized for both facility and professional claims in alignment with CMS guidelines.

The JZ modifier is required to identify that no amount of drug was discarded from a single vial or single package drug or biological. For the administered amount, the claim line should include the billing CPT^®/HCPCS code describing the given drug, the JZ modifier and the number of units administered in the unit’s field.

Visit the UnitedHealthcare Provider Portal for a list of NDCs requiring JZ modifier.

Guidelines for the JW modifier

When filing a claim for discarded drugs and biologicals, providers and facilities are required to follow these guidelines for including the JW modifier:

• Providers and facilities must report the drug amount administered on 1 line, and on a separate line report the amount of drug not administered (discarded) with modifier JW appended to the associated CPT®/HCPCS code.
• When more than 1 vial is administered with different National Drug Codes (NDCs), each NDC used should be reported on a separate claim line along with the appropriate units given from each vial. An additional line is then added indicating the discarded units with modifier JW.
• The JW modifier is only applicable to the amount of the drug discarded and not the amount administered. The JW modifier is not permitted when the actual dose of the drug or biological administered is less than the billing unit.

For more information and answers to frequently asked questions, please see Discarded Drugs and Biologicals Policy, Professional and Facility.