Last Modified: 6/16/2025
Location: FL, PR, USVI
Business: Part A, Part B
The CMS claims processing system has a limit for the total dollar amount submitted per claim. The total digits that can be accepted on a claim is seven. One of the general rules pertaining to an 837P (Part B electronic claim) transaction is the maximum number of characters submitted in any dollar amount field is seven characters. When claim amounts are above $99,999.99, the claim must be split into multiple claims including modifier 76.
Use modifier 76 to indicate repeat services on the subsequent claims and notate in the narrative why the claim is split this way. This will prevent the system from assuming the claims are an exact duplicate. When billing multiple claims ensure that your total dollar amounts are different on each claim.
When a provider must discard the remainder of a single-dose container after administering a dose/quantity of the drug to a Medicare patient, the Medicare Part B program provides payment for the drug amount discarded as well as the dose administered, up to the amount of the drug as indicated on the container or package label. Report the appropriate modifier for the vial usage: discarded amounts vs. no discarded amounts.
• Discarded amounts: JW modifier
• A HCPCS Level II modifier required to be reported on a claim to report the amount of drug that is discarded and is eligible for payment under the discarded drug policy. The modifier should only be used for claims that bill single-dose container drugs.
• No discarded amounts: JZ modifier
• A HCPCS Level II modifier reported on a claim to attest that no amount of drug was discarded and is eligible for payment. The modifier should only be used for claims that bill for single-dose container drugs.
Submit separate claims as follows:
Claim 1
Submit the service with an acceptable dollar amount ($99,999.99 or less):
• Do not use dollar signs, decimals, dashes, or commas for dollar amounts
In the narrative field, identify as “Claim 1 of 2, dollar amount exceeds charge line amount”:
• Item 19 of the CMS 1500 claim form or loop 2400 (line note), segment NTE02 (NTE01=ADD) for electronic claims
If reporting no wastage on this claim, append JZ modifier.
If reporting both wastage and no wastage:
• Append JW to the line for the wastage units
• No modifier for the line for no wastage units.
Note: An appropriate administration code can be billed on the first or second claim, not both, for drug billing.
Claim 2
Enter the charge as the remaining dollar amount for the total charge.
If reporting no wastage on this claim, append JZ and 76 modifier.
If reporting both wastage and no wastage:
• Append JW and 76 modifiers to the line for the wastage units
• 76 modifier for the line for no wastage units
Example:
Drug code JXXXX had 175 units, 150 administered and 25 wasted with a total of $175,000.
Claim 1:
• JXXXX, no modifier billed with 50 units, $50,000
• JXXXX, JW modifier billed with 25 units, $25,000.01
Claim 2:
• JXXXX, 76 JZ modifier billed with 100 units for $99,999.99
If you have claims that were rejected, please resubmit the claims using the above claim submission guidance.
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