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01/20/2021

JA and JB Modifier Requirement - Did You Miss This Update from WPS?

Are you using the Route of Administration Modifier JA or JB that became effective on January 11, 2021?

In December, 2020, WPS Medicare announced an update to their Article on "Billing and Coding: Complex Drug Administration Coding" A58544 with changes effective January 11, 2021.

The Article specifically points out a number of drugs that cannot be billed using the chemotherapy administration codes.  Additionally, and what many of us missed, it also included a modifier requirement for drugs that have one HCPCS code and multiple routes of administration. (i.e. the drug be administered by IV and/or Sub-Q or IM)

Drugs that fall under this category must be billed with;

JA Modifier for the intravenous infusion of the drug

or

JB Modifier for the subcutaneous or intramuscular injection of the drug

 

Many requirements within the Article affect all of the codes listed below however, the modifier requirements only include drugs such as;

Neupogen, Granix, Zarxio, Nivestym, Neulasta, Orencia, Sandostatin

 

Total List:  96365, 96366, 96367, 96368, 96372, 96374, 96375, 96376, 96377, 96379, J0129, J0222, J0485, J0517, J0565, J0638, J0717, J0894, J0896, J0897, J1300, J1301, J1442, J1447, J1602, J2182, J2323, J2353, J2354, J2357, J2505, J2786, J2793, J3245, J3358, J3380, Q5101, Q5108, Q5110, Q5111, Q5120

 

Be careful and be sure to review this Article in its entirety.  Pay close attention to the asterisks in BOTH columns of drugs! 

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