ASP Billing Resources

• JW - JZ Modifier FAQs (PDF): CMS requires providers and suppliers to report the JW modifier on all claims that bill for drugs and biologicals separately payable under Part B with unused and discarded amounts from single-dose containers or single-use packages. If there’s no wastage from single-dose containers or single-use packages, report the claim with the JZ modifier.
• JW Modifier and JZ Modifier Policy HCPCS Codes (PDF) (Updated 11/04/2024): A non-exhaustive list of specific billing and payment codes to which only single-dose containers are assigned, and thus may require use of the JW or JZ modifiers depending on the setting of use.
• Medicare Claims Processing Manual, Pub. 100-04, Chapter 17: View for exceptions including radiopharmaceuticals, biologicals paid using average wholesale price (AWP), and drugs on the NOC file.
• HCPCS Quarterly Update: The official update of the HCPCS code system is available as a public use file. Effective date is noted in each ZIP file.

• Blood Clotting Factor Furnishing Fee:

The Medicare Modernization Act section 303(e)(1) added section 1842(o)(5)(C) of the Social Security Act which requires that, beginning January 1, 2005, a furnishing fee will be paid for items and services associated with clotting factor. 

The Center for Medicare and Medicaid Services (CMS) includes the clotting factor furnishing fee in the published national payment limits for clotting factor billing codes. When the national payment limit for a clotting factor is not included on the Average Sales Price (ASP) Medicare Part B Drug Pricing File or the Not Otherwise Classified (NOC) Pricing File, the contractor must make payment for the clotting factor as well as make payment for the furnishing fee

CMS guidance requires physicians and other providers to bill using the appropriate HCPCS or CPT code and to accurately report the units of service. Physicians and other providers should ensure that the units billed do not exceed the maximum number of units per day based on the code descriptor, reporting instructions associated with the code, and/or other CMS local or national policy.

The prices below reflect the Clotting Factor Furnishing Fee per unit effective January 1st of each year.

Calendar Year – Furnishing Fee per unit

• CY 2005 - $0.140 per unit
• CY 2006 - $0.146 per unit
• CY 2007 - $0.152 per unit
• CY 2008 - $0.158 per unit
• CY 2009 - $0.164 per unit
• CY 2010 - $0.170 per unit
• CY 2011 - $0.176 per unit
• CY 2012 - $0.181 per unit
• CY 2013 - $0.188 per unit
• CY 2014 - $0.192 per unit
• CY 2015 - $0.197 per unit
• CY 2016 - $0.202 per unit
• CY 2017 - $0.209 per unit
• CY 2018 - $0.215 per unit
• CY 2019 - $0.220 per unit
• CY 2020 - $0.226 per unit
• CY 2021 - $0.238 per unit
• CY 2022 - $0.239 per unit
• CY 2023 - $0.250 per unit
• CY 2024 - $0.250 per unit
• CY 2025 - $0.258 per unit

Downloads

2023 - MM12860 (PDF)

2022 - MM12420 (PDF)

2021 - MM11932 (PDF)

2020 - MM11435 (PDF)

2019 - MM10918 (PDF)