Wiki J2785 Denied needs modifier

[barbara@okaloosaheart.com]

J2785 Denied needs modifier. United and now Humana is denying for modifier. This is done in office. Do we use JZ modifier?

 

[mikhaila]

Hello,

You didn't provide specifics but the CMS link below gives scenarios to better discern usage of the JZ modifier.

First link: FAQ for JZ and JW for billing - when and how to use it.

https://www.cms.gov/medicare/medicare-fee-for-service-payment/hospitaloutpatientpps/downloads/jw-modifier-faqs.pdf

Second link: Original article that led me to first link.

https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleid=55932

 

[schottj]

Did the JZ modifier work for your Humana claims?

 

[holbjm@hotmail.com]

I am having Humana Medicare plans deny J2785 for missing modifier. After researching CMS guidelines from 2023 require modifier JZ or JW.

 

[schottj]

I am having Humana Medicare plans deny J2785 for missing modifier. After researching CMS guidelines from 2023 require modifier JZ or JW.

Thank you!

 

[holbjm@hotmail.com]

Did the JZ modifier work for your Humana claims?

It did.

 

[holbjm@hotmail.com]

J2785 Denied needs modifier. United and now Humana is denying for modifier. This is done in office. Do we use JZ modifier?

If there was no waste, you use JZ. There are links provided above on another comment for the guidelines

 

[acartercpc]

I am confused. I have the CMS MCR policy manual fact sheet and medicines with indicator N or N1 do not need these modifiers per their FAQ. I also have the list of drugs that should have these modifier(s), but J2785 is absent from the list. humana and UHC are denying us as well.