As of Jan. 1, 2017, the Centers for Medicare & Medicaid Services (CMS) requires use of modifier JW for claims with unused drugs and biologicals from single-use vials or packages that you discard appropriately.
Modifier JW indicates a Part B drug amount discarded/not administered to any patient. You’ll use this code when you open a single-use package or vial of a drug but don’t administer the entire dose or quantity and discard what’s left.
CMS says it revised its policy to identify and monitor billing and payment more effectively for discarded Part B drugs and biologicals.
The Medicare Claims Processing Manual, Chapter 17, Section 40, provides policy detailing the use of the JW modifier for discarded Part B drugs and biologicals.
It says, in part:
“For example, a single use vial that is labeled to contain 100 units of a drug has 95 units administered to the patient and 5 units discarded. The 95 unit dose is billed on one line, while the discarded 5 units may be billed on another line with the JW modifier. Both line items would be processed for payment.
“The JW modifier is only applied to the amount of drug or biological that is discarded. A situation in which the JW modifier is not permitted is when the actual dose of the drug or biological administered is less than the billing unit.
“For example, one billing unit for a drug is equal to 10 mg of the drug in a single use vial. A 7 mg dose is administered to a patient while 3 mg of the remaining drug is discarded. The 7 mg dose is billed using one billing unit that represents 10 mg on a single line item. The single line item of 1 unit would be processed for payment of the total 10 mg of drug administered and discarded. Billing another unit on a separate line item with the JW modifier for the discarded 3 mg of drug is not permitted because it would result in overpayment. Therefore, when the billing unit is equal to or greater than the total actual dose and the amount discarded, the use of the JW modifier is not permitted.”
See more information from Notivas Solutions, and FAQs from CMS.
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Revised Jan. 9, 2017
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Last Updated On
January 13, 2017
Originally Published On
May 27, 2016