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Mayo Foundation for Medical Education and Research

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Key Medicare billing rules for J3380: Bill under the Part B drug benefit , not Part D (which covers self-administered drugs) Use place of service code 22 (outpatient hospital) or 11 (physician office) depending on where the infusion occurs Modifier JW is required if any drug is wasted from a single-use vial and discarded (report the discarded amount separately) Modifier JZ indicates no drug was wasted – use when the full vial is administered Traditional Medicare does not require prior authorization for Part B biologics, but Medicare Advantage plans may apply their own PA requirements Practices managing the full infusion billing cycle can look up HCPCS codes, verify unit billing requirements, and cross-reference fee schedules using the AAPC Codify HCPCS lookup