05/20/2026

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May 2026 Frequently Asked Questions

Question:

What should providers do when the administered drug dose does not match the total units in a single-dose container and no waste is documented?

Answer:

Providers should implement a sound practice to code and bill the applicable units based on the entire package administered, and documentation should reflect the entire dosage was administered to the patient. It is not recommended to apply this modifier as an alternative to the JW modifier when it is not apparent in the infusion record or medication administration record (MAR) whether the entire amount of the single-dose or single-use drug was used. Meaning, if the documented total amount/dose administered does not equal the number of units for the entire container or package, and the clinician fails to document any discarded/wasted drug, it would not be appropriate to apply modifier JZ to the HCPCS code. (Modifier JW Fact Sheet) (JW and JZ Modifier FAQs)

Question:

When was the JZ modifier first introduced, and what are the requirements for reporting?

Answer:

Medicare first introduced the JZ modifier on January 1, 2023; however, the modifier was not required for use until July 1, 2023, and Medicare began editing for use of the modifier on October 1 of the same year. Refer to MLN Matters Number MM13056 https://www.cms.gov/files/document/mm13056-new-jz-claims-modifier-certain-medicare-part-b-drugs.pdf.

This modifier is required on any outpatient hospital 1450 claim containing single-dose or single-use containers and packages where the billed HCPCS code is assigned to a status indicator K (Nonpass-Through Drugs and Nonimplantable Biologicals, Including Therapeutic Radiopharmaceuticals) or G (Pass-Through Drugs and Biologicals) paid as a separate APC under the OPPS. The main purpose of reporting the JZ modifier is to indicate to Medicare that the provider has administered the entire vial or container of the single-dose or single-use drug to the beneficiary.

Question:

When an APP is supervising chemotherapy is the administration code and the chemo drug reduced by 15% reimbursement?

Answer:

1. Chemotherapy administration codes (e.g., 96413, 96367, etc.)

If billed under the PA or NP’s NPI, Medicare pays 85% of the Physician Fee Schedule (PFS) for the administration service. This is because PA/NP services are paid at 85% when directly billed under their own NPI.

2. Chemotherapy drugs (e.g., J-codes)

These are not paid at 85%. Drugs are paid based on ASP + 6% (or +4.3% sequestration-adjusted) and are not reduced when a PA or NP supervises or bills the service.

Medicare treats the drug as a separately payable supply, not a professional service — therefore the 85% rule does not apply.

3. Supervision rules

PAs and NPs can supervise chemotherapy administration if allowed by state scope of practice and clinic policy, and Medicare accepts their supervision for billing purposes.

Physician Assistants (PAs) | CMS