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March 14, 2024

Policy Article Revisions Summary for March 14, 2024

Joint DME MAC Publication

Outlined below are the principal changes to the DME MAC Policy Articles (PAs) that have been revised and posted. The policies included are External Infusion Pumps, Intravenous Immune Globulin and Nebulizers. Please review the entire Local Coverage Determinations (LCDs) and related PAs for complete information.

External Infusion Pumps

PA

External Infusion Pumps PAExternal Website

Revision Effective Date: 01/12/2024

MODIFIERS:

  • Added: "Effective January 1, 2024, the JZ modifier is also required when billing for drugs and biologicals from single-dose containers that are dispensed by the supplier but self-administered by the beneficiary or the beneficiary's caregiver."
  • Revised: "The JW and JZ modifiers are not required for drugs dispensed by the supplier and self-administered by the patient or caregiver in the patient's home." to "The JW modifier is not required for drugs dispensed by the supplier and self-administered by the beneficiary or caregiver in the beneficiary's home, as it is not expected that the beneficiary or their caregiver provide discarded drug information to the supplier. The JZ modifier is required in this scenario (effective for claims with dates of service on or after January 1, 2024)."
  • Removed: The JZ modifier from the statement regarding expected rare use
  • Added: "As of July 1, 2023, the JZ modifier is required in this situation." to Scenario 2
  • Added: Information to include the JZ modifier in the billing instructions for the 70 mg dose in Scenario 2

03/14/2024: At this time the 21st Century Cures Act applies to new and revised LCDs which require comment and notice. This revision is to an article that is not a local coverage determination.

Intravenous Immune Globulin

PA

Intravenous Immune Globulin PAExternal Website

Revision Effective Date: 01/01/2024

MODIFIERS:

  • Added: "Effective January 1, 2024, the JZ modifier is also required when billing for drugs and biologicals from single-dose containers that are dispensed by the supplier but self-administered by the beneficiary or the beneficiary's caregiver."
  • Revised: "The JW and JZ modifiers are not required for drugs dispensed by the supplier and self-administered by the patient or caregiver in the patient's home." to "The JW modifier is not required for drugs dispensed by the supplier and self-administered by the beneficiary or caregiver in the beneficiary's home, as it is not expected that the beneficiary or their caregiver provide discarded drug information to the supplier. The JZ modifier is required in this scenario (effective for claims with dates of service on or after January 1, 2024)."
  • Removed: The JZ modifier from the statement regarding expected rare use
  • Added: "As of July 1, 2023, the JZ modifier is required in this situation." to Scenario 2
  • Added: Information to include the JZ modifier in the billing instructions for the 70 mg dose in Scenario 2

03/14/2024: At this time the 21st Century Cures Act applies to new and revised LCDs which require comment and notice. This revision is to an article that is not a local coverage determination.

Nebulizers

PA

Nebulizers PAExternal Website

Revision Effective Date: 01/01/2024

MODIFIERS:

  • Added: "Effective January 1, 2024, the JZ modifier is also required when billing for drugs and biologicals from single-dose containers that are dispensed by the supplier but self-administered by the beneficiary or the beneficiary's caregiver."
  • Revised: "The JW and JZ modifiers are not required for drugs dispensed by the supplier and self-administered by the patient or caregiver in the patient's home." to "The JW modifier is not required for drugs dispensed by the supplier and self-administered by the beneficiary or caregiver in the beneficiary's home, as it is not expected that the beneficiary or their caregiver provide discarded drug information to the supplier. The JZ modifier is required in this scenario (effective for claims with dates of service on or after January 1, 2024)."
  • Removed: The JZ modifier from the statement regarding expected rare use.
  • Added: "As of July 1, 2023, the JZ modifier is required in this situation." to Scenario 2
  • Added: Information to include the JZ modifier in the billing instructions for the 70 mg dose in Scenario 2

03/14/2024: At this time the 21st Century Cures Act applies to new and revised LCDs which require comment and notice. This revision is to an article that is not a local coverage determination.

Note: The information contained in this article is only a summary of revisions to the LCDs and/or PAs. For complete information on any topic, you must review the LCDs and/or PAs.

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