Medical Billing Terms J: Medicare MAC Jurisdictions, JW and JZ Modifiers

Also called TJC; JCAHO

Definition

The Joint Commission is an accrediting organization. It accredits behavioral health organizations under its Comprehensive Accreditation Manual for Behavioral Health Care, covering community-based mental health, substance use, crisis stabilization, outpatient and day programs, and peer support. This entry points to the full definition under The Joint Commission.

Why it matters

Accreditation can matter to payers and programs that ask for it. Its standards focus on the systems behind safety and quality.

Illustrative example

A clinic asks whether accreditation is needed before it applies to a payer program.

Related termsThe Joint CommissionMeasurement-Based Care (Joint Commission)Accreditation

Reference sourceThe Joint Commission: Behavioral Health Care Accreditation Fact Sheetchecked 10/9/26

CategoriesCredentialing & EnrollmentQuality & Risk Adjustment Terms

Also called J15 MAC; Medicare jurisdiction J15

Definition

Jurisdiction J15 is the Medicare A/B MAC jurisdiction covering Kentucky and Ohio. National Government Services (NGS) is the contractor that processes Medicare Part A and Part B claims there.

Why it matters

Knowing the jurisdiction tells you which contractor handles Medicare Part B enrollment, claims, local coverage rules and appeals for a practice in these states. CMS also lists home health and hospice (HH+H) claims processing for part of this area, and those areas do not match the A/B jurisdictions.

Illustrative example

A prescriber in Ohio contacts the J15 contractor about a Medicare Part B enrollment question.

Related termsMAC JurisdictionMedicare Administrative Contractor (MAC)

Reference sourceCMS: Who are the MACschecked 10/9/26

CategoriesMedicare & Medicaid TermsCredentialing & Enrollment

Also called J5 MAC; Medicare jurisdiction J5

Definition

Jurisdiction J5 is the Medicare A/B MAC jurisdiction covering Iowa, Kansas, Missouri and Nebraska. Wisconsin Physicians Service Insurance Corporation (WPS) is the contractor that processes Medicare Part A and Part B claims there.

Why it matters

Knowing the jurisdiction tells you which contractor handles Medicare Part B enrollment, claims, local coverage rules and appeals for a practice in these states.

Illustrative example

A psychiatrist in Kansas enrolling in Medicare sends the enrollment application to the J5 contractor, WPS.

Related termsMAC JurisdictionMedicare Administrative Contractor (MAC)

Reference sourceCMS: Who are the MACschecked 10/9/26

CategoriesMedicare & Medicaid TermsCredentialing & Enrollment

Also called J6 MAC; Medicare jurisdiction J6

Definition

Jurisdiction J6 is the Medicare A/B MAC jurisdiction covering Illinois, Minnesota and Wisconsin. Wisconsin Physicians Service Insurance Corporation (WPS) is the contractor that processes Medicare Part A and Part B claims there.

Why it matters

Knowing the jurisdiction tells you which contractor handles Medicare Part B enrollment, claims, local coverage rules and appeals for a practice in these states. CMS also lists home health and hospice (HH+H) claims processing for part of this area, and those areas do not match the A/B jurisdictions.

Illustrative example

A psychotherapist in Illinois checks the J6 contractor's website for local billing rules before submitting a Medicare claim.

Related termsMAC JurisdictionMedicare Administrative Contractor (MAC)

Reference sourceCMS: Who are the MACschecked 10/9/26

CategoriesMedicare & Medicaid TermsCredentialing & Enrollment

Also called J8 MAC; Medicare jurisdiction J8

Definition

Jurisdiction J8 is the Medicare A/B MAC jurisdiction covering Indiana and Michigan. Wisconsin Physicians Service Insurance Corporation (WPS) is the contractor that processes Medicare Part A and Part B claims there.

Why it matters

Knowing the jurisdiction tells you which contractor handles Medicare Part B enrollment, claims, local coverage rules and appeals for a practice in these states.

Illustrative example

A group practice in Michigan looks up the J8 contractor to find the right portal for Medicare claim status.

Related termsMAC JurisdictionMedicare Administrative Contractor (MAC)

Reference sourceCMS: Who are the MACschecked 10/9/26

CategoriesMedicare & Medicaid TermsCredentialing & Enrollment

Also called JE MAC; Medicare jurisdiction JE

Definition

Jurisdiction JE is the Medicare A/B MAC jurisdiction covering California, Hawaii, Nevada, American Samoa, Guam and the Northern Mariana Islands. Noridian Healthcare Solutions is the contractor that processes Medicare Part A and Part B claims there. CMS's MACs by State list marks this jurisdiction "Transition In Progress", so confirm the current contractor before you rely on it.

Why it matters

Knowing the jurisdiction tells you which contractor handles Medicare Part B enrollment, claims, local coverage rules and appeals for a practice in these states.

Illustrative example

A practice in Nevada finds that its Medicare claims go to the JE contractor.

Related termsMAC JurisdictionMedicare Administrative Contractor (MAC)

Reference sourceCMS: Who are the MACschecked 10/9/26

CategoriesMedicare & Medicaid TermsCredentialing & Enrollment

Also called JF MAC; Medicare jurisdiction JF

Definition

Jurisdiction JF is the Medicare A/B MAC jurisdiction covering Alaska, Arizona, Idaho, Montana, North Dakota, Oregon, South Dakota, Utah, Washington and Wyoming. Noridian Healthcare Solutions is the contractor that processes Medicare Part A and Part B claims there.

Why it matters

Knowing the jurisdiction tells you which contractor handles Medicare Part B enrollment, claims, local coverage rules and appeals for a practice in these states.

Illustrative example

A therapist in Oregon uses the JF contractor's resources to check Medicare billing rules.

Related termsMAC JurisdictionMedicare Administrative Contractor (MAC)

Reference sourceCMS: Who are the MACschecked 10/9/26

CategoriesMedicare & Medicaid TermsCredentialing & Enrollment

Also called JH MAC; Medicare jurisdiction JH

Definition

Jurisdiction JH is the Medicare A/B MAC jurisdiction covering Arkansas, Colorado, Louisiana, Mississippi, New Mexico, Oklahoma and Texas. Novitas Solutions is the contractor that processes Medicare Part A and Part B claims there.

Why it matters

Knowing the jurisdiction tells you which contractor handles Medicare Part B enrollment, claims, local coverage rules and appeals for a practice in these states.

Illustrative example

A psychiatry practice in Texas or Colorado sends Medicare Part B claims to the JH contractor, Novitas.

Related termsMAC JurisdictionMedicare Administrative Contractor (MAC)

Reference sourceCMS: Who are the MACschecked 10/9/26

CategoriesMedicare & Medicaid TermsCredentialing & Enrollment

Also called JJ MAC; Medicare jurisdiction JJ

Definition

Jurisdiction JJ is the Medicare A/B MAC jurisdiction covering Alabama, Georgia and Tennessee. Cahaba Government Benefit Administrators is the contractor that processes Medicare Part A and Part B claims there.

Why it matters

Knowing the jurisdiction tells you which contractor handles Medicare Part B enrollment, claims, local coverage rules and appeals for a practice in these states.

Illustrative example

A practice in Georgia or Tennessee reaches the JJ contractor, Cahaba, for Medicare enrollment and claims questions.

Related termsMAC JurisdictionMedicare Administrative Contractor (MAC)

Reference sourceCMS: Who are the MACschecked 10/9/26

CategoriesMedicare & Medicaid TermsCredentialing & Enrollment

Also called JK MAC; Medicare jurisdiction JK

Definition

Jurisdiction JK is the Medicare A/B MAC jurisdiction covering Connecticut, Maine, Massachusetts, New Hampshire, New York, Rhode Island and Vermont. National Government Services (NGS) is the contractor that processes Medicare Part A and Part B claims there. CMS's MACs by State list marks this jurisdiction "Transition In Progress", so confirm the current contractor before you rely on it.

Why it matters

Knowing the jurisdiction tells you which contractor handles Medicare Part B enrollment, claims, local coverage rules and appeals for a practice in these states. CMS also lists home health and hospice claims processing for these states other than New York.

Illustrative example

A practice in Massachusetts, Connecticut or New York uses the JK contractor for Medicare Part B questions.

Related termsMAC JurisdictionMedicare Administrative Contractor (MAC)

Reference sourceCMS: Who are the MACschecked 10/9/26

CategoriesMedicare & Medicaid TermsCredentialing & Enrollment

Also called JL MAC; Medicare jurisdiction JL

Definition

Jurisdiction JL is the Medicare A/B MAC jurisdiction covering Delaware, the District of Columbia, Maryland, New Jersey and Pennsylvania. Novitas Solutions is the contractor that processes Medicare Part A and Part B claims there. CMS's MACs by State list marks this jurisdiction "Transition In Progress", so confirm the current contractor before you rely on it.

Why it matters

Knowing the jurisdiction tells you which contractor handles Medicare Part B enrollment, claims, local coverage rules and appeals for a practice in these states.

Illustrative example

A practice in Pennsylvania confirms the current JL contractor before submitting an enrollment application.

Related termsMAC JurisdictionMedicare Administrative Contractor (MAC)

Reference sourceCMS: Who are the MACschecked 10/9/26

CategoriesMedicare & Medicaid TermsCredentialing & Enrollment

Also called JM MAC; Medicare jurisdiction JM

Definition

Jurisdiction JM is the Medicare A/B MAC jurisdiction covering North Carolina, South Carolina, Virginia and West Virginia. Palmetto GBA is the contractor that processes Medicare Part A and Part B claims there.

Why it matters

Knowing the jurisdiction tells you which contractor handles Medicare Part B enrollment, claims, local coverage rules and appeals for a practice in these states. CMS also lists home health and hospice (HH+H) claims processing for part of this area, and those areas do not match the A/B jurisdictions.

Illustrative example

A practice in North Carolina sends Medicare Part B claims to the JM contractor, Palmetto GBA.

Related termsMAC JurisdictionMedicare Administrative Contractor (MAC)

Reference sourceCMS: Who are the MACschecked 10/9/26

CategoriesMedicare & Medicaid TermsCredentialing & Enrollment

Also called JN MAC; Medicare jurisdiction JN

Definition

Jurisdiction JN is the Medicare A/B MAC jurisdiction covering Florida, Puerto Rico and the U.S. Virgin Islands. First Coast Service Options is the contractor that processes Medicare Part A and Part B claims there.

Why it matters

Knowing the jurisdiction tells you which contractor handles Medicare Part B enrollment, claims, local coverage rules and appeals for a practice in these states.

Illustrative example

A practice in Florida finds that its Medicare Part B claims go to the JN contractor, First Coast.

Related termsMAC JurisdictionMedicare Administrative Contractor (MAC)

Reference sourceCMS: Who are the MACschecked 10/9/26

CategoriesMedicare & Medicaid TermsCredentialing & Enrollment

Also called discarded drug modifier

Definition

A JW modifier is a HCPCS Level II modifier that reports the amount of a separately payable Part B drug that was discarded from a single-dose container or single-use package. It has been required since January 1, 2017.

Why it matters

Prescribers who bill long-acting injectables need it when part of a vial is wasted. CMS uses discarded-drug reporting to calculate refunds from manufacturers starting January 1, 2023.

Illustrative example

A psychiatrist administers part of a single-dose vial of a separately payable Part B drug and reports the wasted amount with the JW modifier.

Related termsJZ ModifierLong-Acting Injectable (LAI) Administration

Reference sourceCMS: JW Modifier FAQschecked 10/9/26

CategoriesCPT, E/M & HCPCS Code EntriesMedicare & Medicaid Terms

Also called no discarded drug modifier

Definition

A JZ modifier is a HCPCS Level II modifier that attests that no drug was discarded from a single-dose container or single-use package. It became available January 1, 2023, and CMS required it no later than July 1, 2023.

Why it matters

Claims for separately payable single-dose Part B drugs can be returned as unprocessable if they lack the right modifier. It does not apply to rural health clinics, federally qualified health centers, inpatient hospital stays paid under IPPS, or roster-billed vaccines.

Illustrative example

A prescriber uses a full single-dose syringe, so the claim line carries the JZ modifier.

Related termsJW ModifierLong-Acting Injectable (LAI) Administration

Reference sourceCMS: JW Modifier FAQschecked 10/9/26

CategoriesCPT, E/M & HCPCS Code EntriesMedicare & Medicaid Terms