Update: Reimbursement Policy Update: Some Modifier JZ/JW Claims to be Reprocessed

Update February 21, 2025: Recently, Blue Cross NC identified and fixed a temporary issue that caused denials for some claims that appropriately used the JW/JZ modifier. Any claims denied between November 1, 2024 and January 31, 2025, and appropriately used a JW/JZ modifier, will automatically be reprocessed. There is nothing providers need to do at this time.

Our policy remains the same, and Modifier JW or JZ is required on claims for single-use vial or package of drugs or biologicals. Additional information and examples of when a JZ or JW modifier is appropriate was posted here.

This processing error impacted Commercial, Inter-Plan Program (IPP) Host and Medicare Advantage.  

Effective November 1, 2024, Blue Cross and Blue Shield of North Carolina (Blue Cross NC) is implementing a revision to the reimbursement policy Drugs and Biologicals. 

Consistent with CMS, Modifier JZ will now be required for a single-use vial or package when there is no discarded/wasted drug or biological. Modifier JW will continue to be required when there is discarded/wasted drugs or biologicals from a single use-vial or package. 

In general, Modifier JW or JZ will be required on claims for single-use vial or package of drugs or biologicals. Failure to include Modifier JW or JZ will result in claim denial. Please see the related policy notification for more information.

This Modifier JZ requirement will ensure wastage is accurately coded on the claim – providing more insight and clarity into drug wastage and improving claim adjudication accuracy.

This change will apply to Commercial, Inter-Plan Program (IPP) Host, State Health Plan, Senior Market Administration (SMA), and Federal Employee Program (FEP). This will not apply to IPP Home.