Wiki JZ & JW modifiers

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Dillon

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Can anyone confirm whether the JZ/JW modifiers are needed on vaccines? I’m aware of the CMS FAQ and the response, see below, but it seems as if it’s only addressing the vaccines listed in section 1861(s)(10), see below, which is influenza, pneumococcal, hep B and COVID-19 stating the modifiers are not required on those vaccines. That makes me think single-dose vial vaccines require a JZ modifier. If it’s your understanding a JZ modifier is not needed, can you share your source?
Thank you in advance.

jw-modifier-faqs.pdf (cms.gov)
The JW and JZ modifiers are not required for vaccines described under section 1861(s)(10) of the Act that are furnished from single-dose containers. Since the influenza, pneumococcal, and COVID–19 vaccines, specified in section 1861(s)(10) of the Act, are often roster billed by mass immunizers, and roster billing cannot accommodate modifiers, it would be impractical to require the JW and JZ modifiers for such vaccines. Such a requirement would likely result in substantial operational issues for mass immunizers and impair patient access to these vaccines.

Social Security Act §1861 (ssa.gov)
(10)(A) pneumococcal vaccine and its administration and, subject to section 4071(b) of the Omnibus Budget Reconciliation Act of 1987[505], influenza vaccine and its administration; and
(B) hepatitis B vaccine and its administration, furnished to an individual who is at high or intermediate risk of contracting hepatitis B (as determined by the Secretary under regulations);
 
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ok I found this on the internet:

✅ Vaccines that are exempt from JZ/JW modifiers:​

  • Influenza
  • Pneumococcal
  • Hepatitis B
  • COVID-19
These are listed under Section 1861(s)(10) of the Social Security Act and are explicitly exempt from the JZ/JW modifier requirement due to their widespread use and roster billing limitations. [aapc.com], [bluecrossnc.com]

⚠️ Vaccines that are not exempt and may require JZ/JW:​

  • Yellow fever
  • MMR (e.g., CPT 90707)
  • Tdap/Tetanus (e.g., CPT 90715)
  • Other travel or childhood vaccines
These are not listed under Section 1861(s)(10), so if they are:
  • Separately payable under Medicare Part B, and
  • Supplied in single-dose containers,
    then JZ modifier is required if no wastage, and JW modifier if some of the dose is discarded.
Hi Dillon, Did you ever get a response to your question? We are currently investigating the same question in relation to vaccines.Thanks!

The reason the JZ modifier is required for CAPVAXIVE (Prevnar 21) but not for vaccines like flu, Hepatitis B, or COVID-19 comes down to Medicare policy exceptions.

Here's the breakdown:​

✅ Why CAPVAXIVE needs the JZ modifier:​

  • CAPVAXIVE is a single-dose syringe and is separately payable under Medicare Part B.
  • CMS requires the JZ modifier on claims for single-dose container drugs when no portion is discarded.
  • This helps Medicare track drug wastage and ensure accurate reimbursement.

❌ Why flu, Hep B, and COVID-19 vaccines do not need JZ/JW modifiers:​

  • These vaccines are listed under Section 1861(s)(10) of the Social Security Act.
  • CMS exemptsthese vaccines from the JZ/JW modifier requirement because:
    • They are often roster billed by mass immunizers (like pharmacies or clinics).
    • Roster billing systems don’t support modifiers, and requiring them would cause operational issues.
    • The exemption helps maintain easy access to these widely administered vaccines. [bluecrossnc.com], [aapc.com], [billing-coding.com]

Summary:​

  • CAPVAXIVE: JZ required if no wastage.
  • Flu, Hep B, COVID-19: JZ/JW not required due to CMS exemption for mass immunization logistics.
Reimbursement Policy Modifier JZ Requirement: Update - Vaccine and Monoclonal Antibody Products
 
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