Stay up to date with rheumatology news & updates by subscribing to receive the free RPM print publications or e‑Newsletters.
The JW modifier is described by Current Procedural Terminology as “drug amount discarded/not administered to any patient.”1 Historically, the Centers for Medicare & Medicaid Services (CMS) allowed Medicare Administrative Contractors (MACs) the discretion to determine whether to require the JW modifier for any claims with discarded drugs or biologicals, and the specific details regarding how the discarded drug or biological information should be documented. However, to more effectively identify and monitor billing and payment for discarded drugs and biologicals, CMS has revised this policy to require the uniform use of the JW modifier for all claims with discarded Part B drugs and biologicals.
In June 2016, updates were made to Section 40 (ie, Discarded Drugs and Biologicals) of Chapter 17 of the Medicare Claims Processing Manual,1 which became effective January 1, 2017.2 CMS has revised this policy to require the uniform use of the JW modifier for all claims with discarded Part B drugs and biologicals, and has now alerted MACs that providers are required to use the JW modifier for claims with unused drugs or biologicals from single-use vials or packages that are appropriately discarded (except for those provided under the Competitive Acquisition Program for Part B drugs and biologicals), and that providers are now required to document the discarded drug or biological in the patient’s medical record.
CMS has removed MACs’ discretion to determine whether the JW modifier is required for claims with discarded drugs and biologicals.
It is important that you check with your MAC as to how the JW modifier is to be reported on the claim, and understand that their guidance may have changed more than once since the effective date of this policy. For example, when the revised policy was first implemented, the First Coast Service Options initially directed the provider to combine on a single line the wastage and administered dosage amount and append JW to the single line. Effective February 28, 2017, however, First Coast Service Options revised their guidance to reflect that claims for drug wastage must be billed using 2 individual lines3:
When the actual administered dose of the drug or biological is less than the billing unit, the JW modifier is not permitted. For example, if 7 mg were administered to a patient from a 10-mg single-use vial (with the 10 mg representing 1 unit), the administered and discarded amounts cannot be split for billing purposes.
Most, if not all, other MACs also now require that the amounts administered and wasted be reported on 2 separate lines with JW modifiers only assigned to the lines reporting wastage. The following examples for when and when not to bill with a JW modifier are provided by Palmetto GBA4 and Novitas Solutions5:
National Government Services provides even more detailed guidance regarding the dollar amounts reported6:
Read Now