KMAP BULLETIN: VYJUVEK BILLING GUIDANCE

Date: 04/29/25

KMAP GENERAL BULLETIN 25099 (PDF)

Medicaid as Primary or Secondary Payer
Date of Service: 7/31/2023 through 12/31/2023
Maximum Dose per Visit: 1.6 or 0.8 ML

DETAIL #	HCPCS	HCPCS MODIFIER	HCPCS UNITS	NDC	NDC UOM	NDC UNITS	NDC PRICE	COMPOUND/LINKAGE NUMBER
1	J3590	JZ	1	82194051002	EA	1	$0.00	12345

 

NOTE: For J3490 or J3590, the expectation is one detail with a total of 1 HCPCS unit. No waste recorded.

NDC Units and NDC UOM from the example must be used.

JZ modifier can be used in this instance. Medicare requires JZ modifier in this situation.

Medicare Crossover
Date of Service: On or after 1/1/2024
Maximum Dose per Visit: 1.6 ML

DETAIL #	HCPCS	HCPCS MODIFIER	HCPCS UNITS	NDC	NDC UOM	NDC UNITS	NDC PRICE	COMPOUND/LINKAGE NUMBER
1	J3401		16	82194051002	EA	0.64	$0.00	23456
2	J3401	JW	9	82194051002	EA	0.36	$0.00	23456

 

Medicare Crossover
Date of Service: On or after 1/1/2024
Maximum Dose per Visit: 0.8 ML 

DETAIL #	HCPCS	HCPCS MODIFIER	HCPCS UNITS	NDC	NDC UOM	NDC UNITS	NDC PRICE	COMPOUND/LINKAGE NUMBER
1	J3401		8	82194051002	EA	0.32	$0.00	34567
2	J3401	JW	17	82194051002	EA	068	$0.00	34567

 

NOTE: For the J3401 Medicare crossovers examples, the expectation is at least two details totaling 25 HCPCS units.

One detail for the amount administered.

One detail for the amount discarded (JW modifier).

Medicaid (No Medicare)
Date of Service: On or after 1/1/2024
Maximum Dose per Visit: 0.8 ML or 1.6 ML

DETAIL #	HCPCS	HCPCS MODIFIER	HCPCS UNITS	NDC	NDC UOM	NDC UNITS	NDC PRICE	COMPOUND/LINKAGE NUMBER
1	J3401		25	82194051002	EA	1	$0.00	34567

NOTE: Billing expectation for J3401 totals 25 HCPCS units.

Use of the JW modifier is not required.