Skip to main content

Zyvox (Linezolid) to Require JW Modifier Effective January 1, 2023

Last updated on

Note: Texas Medicaid managed care organizations (MCOs) must provide all medically necessary, Medicaid-covered services to eligible clients. Administrative procedures such as prior authorization, precertification, referrals, and claims/encounter data filing may differ from traditional Medicaid (fee-for-service) and from MCO to MCO. Providers should contact the client's specific MCO for details.

Effective for dates of service on or after January 1, 2023, claims submitted for procedure code J2020 for Zyvox (linezolid) for the unused portion and discarded portion of weight-based or variable dosing clinician-administered drugs (CADs) manufactured only in single-dose vials, must include the modifier JW for consideration of reimbursement. The JW modifier on the claim identifies the unused portion and discarded portion of the vial contents.

Reimbursement

Procedure code J2020 is a benefit of Medicaid for clients of all ages for the following providers and places of service:

Place of Service

Provider Type

Office

Physician assistant, nurse practitioner, clinical nurse specialist, physician, clinic or group practice

Outpatient hospital

Hospital

Providers may refer to the web article that was posted to tmhp.com on August 10, 2020, for additional information.

For more information, call the TMHP Contact Center at 800-925-9126.