This page is a central location for drug and biological information, including CMS resources.

Spotlight

• Appropriate Drug Billing for Part A

• Appropriate Drug Billing for Part B

• Drugs and Biologicals Part A – Using the JW and JZ Modifiers

• Drugs and Biologicals Part B – Using the JW and JZ Modifiers

• ITVISMA® Cell Gene Therapy Drug: Get Billing Guidance

Policy Information

Not all services have a policy associated with them. We will consider Reasonable and Necessary Guidelines in the absence of an LCD, billing and coding article, NCD, or CMS manual instruction that limits coverage.

LCDs

Learn more about the LCD development process through the following:

• LCD Development Process
• Journey to LCD Coverage

Search for drugs and biologicals-related LCDs using these available resources:

• LCD Interactive Index Tool
• View active / proposed LCDs on CMS Medicare Coverage Database (MCD)

NCDs

Search for drugs and biologicals-related NCDs using these available tools:

• Search CMS MCD
   

Medical Documentation

For a claim to be valid, documentation must demonstrate compliance with all applicable coverage, coding and billing requirements and substantiate the level of care billed. The following resources are specific to drugs and biologicals, but may not address all required medical documentation requirements:

• Medical Documentation Checklists
• Checklist: Drugs, Biologicals and Injection Services Documentation

Claim Submission and Reimbursement

• Appropriate Use of Not Otherwise Classified Codes When Billing Drugs and Biologicals

• Drugs and Biologicals Part A – Using the JW and JZ Modifiers

• Drugs and Biologicals Part B – Using the JW and JZ Modifiers

• Fee Development Process of New Drug Code Pricing
• Patients Purchasing Their Own Drugs and Biologicals (Brown Bagging)
• Reporting the National Drug Code
• Submitting High Dollar Claims for Single Use Vials
• Understanding Radiopharmaceutical Fee Schedule Amounts and Billing Expectations
• Understanding Local Contractor Pricing
• Use of JW and JZ Modifiers When Billing for Separately Payable Incident-to Supplies
• Quarterly Drug Pricing Files:
  • MLN Connects Newsletter for September 24, 2026: Claims, Pricers & Codes - Medicare Part B Drug Pricing Files & Revisions: October Update
  • MLN Connects Newsletter for June 25, 2026: Claims, Pricers & Codes - Medicare Part B Drug Pricing Files & Revisions: July Update 
  • MLN Connects Newsletter for March 26, 2026: Claims, Pricers & Codes - Medicare Part B Drug Pricing Files & Revisions: April Update 
  • MLN Connects Newsletter for January 8, 2026: Claims, Pricers &Codes - Medicare Part B Drug Pricing Files & Revisions: January Update 

Additional Information

• View our FastTrack to Medicare Coverage Policies Tool to locate guidelines
• Drugs & Biologicals: Self-administered Drug Exclusions
• SPRAVATO® (Esketamine) Nasal Spray, CIII - Place of Service (POS) Requirements

CMS

• CMS IOM Pub. 100-02 Medicare Benefit Policy Manual, Chapter 6, Section 30
• CMS IOM Pub. 100-02 Medicare Benefit Policy Manual, Chapter 15, Section 50 and 60

• CMS IOM Pub. 100-04 Medicare Claims Processing Manual, Chapter 12, Section 20 and 30
• CMS IOM Pub. 100-04 Medicare Claims Processing Manual, Chapter 17, Section 40
• Discarded Drugs and Biologicals – JW Modifier and JZ Modifier Policy HCPCS Codes
• Medicare Program Discarded Drugs and Biologicals – JW Modifier and JZ Modifier Policy Frequently Asked Questions
• Medicare Part B Inflation Rebate Guidance: Use of the 340B Modifier
• Medicare Provider Compliance Tips: Immunosuppressive Drugs

• Billing 340B Modifiers Under the Hospital Outpatient Prospective Payment System (OPPS)

Education

View our wide selection of free, live and on-demand training options:

• Educational Events Calendar
• On-Demand Learning
   

Stay Informed

Stay updated on the latest Medicare information with free email subscriptions:

• Subscribe to eNews
• CMS.gov MLN Connects Newsletter