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Medical Coding News Archives

Medicare Requires Providers to Assign Modifier JW

 
June 22, 2016:

Effective January 1, 2017, claims for drugs or biological substances that contain a portion of the substance that is not administered to any patient must be submitted using modifier JW. Previously, Medicare allowed contractors the discretion to determine whether to require modifier JW when discarding drug or biological substances. Additionally, Medicare is requiring that the provider document the amount of the discarded drugs or biologicals in the patient's medical record.

JW Drug amount discarded/not administered to any patient

When a provider or supplier must discard the remainder of a single-use vial or other single-use package after administering a dose/quantity of the drug or biological to a Medicare patient, Medicare pays for the amount of the drug or biological discarded as well as the dose administered, up to the amount of the drug or biological as indicated on the vial or package label.

Effective January 1, 2017, when processing claims for drugs and biologicals (except those provided under the Competitive Acquisition Program for Part B drugs and biologicals [CAP]), local contractors will require modifier JW to identify the unused portion of drugs or biologicals from single-use vials or single-use packages that are appropriately discarded. This modifier, billed on a separate line, will ensure payment for the amount of discarded drug or biological.

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 are billed on another line by using modifier JW. Both line items would be processed for payment. As stated above, the discarded amounts of drugs and biologicals must be documented in the patient’s medical record.

Modifier JW is applied only to the amount of drug or biological that is discarded. Using modifier JW is not permitted 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 modifier JW 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 modifier JW is not permitted.

Modifier JW is not used on claims for CAP drugs. Multi-use vials are not subject to payment for discarded amounts of drugs or biologicals.

 

 
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