MedicaidBilling CodesHigh impact
[Indiana] Modifiers JZ and JW
CareSource·IN · Pharmacy·Provider Bulletin
Effective date
Mar 21, 2025
We identified it
May 9, 2026
Summary
CareSource Indiana Medicaid is enforcing Single Dose Vial (SDV) modifier requirements effective immediately. Providers must bill fully-administered vials with JZ modifier, and partially-administered vials with two claim lines (one for administered amount with no modifier, one for discarded amount with JW modifier). Claims missing these modifiers will be denied with 'Missing Procedure Modifier' remark code.
Action Required
Immediately: Billing team must update claims submission process to enforce SDV modifier coding requirements in billing software. (1) For all drug claims with fully-administered single-dose vials: add JZ modifier to claim line. (2) For all drug claims with partially-administered single-dose vials: split into two claim lines—first line shows administered amount without modifier, second line shows discarded amount with JW modifier. (3) When responding to 'Missing Procedure Modifier' denials, submit corrected claims using the above instructions; do not appeal. Train all staff submitting drug claims to Indiana Medicaid. Update billing workflows and encounter templates to remind providers of SDV billing requirements. Failure to apply correct modifiers will result in claim line denials.