Avoid claim denials: Bill drug wastage correctly using the JW modifier

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Home ► Appeals ► Avoid claim denials: Bill drug wastage correctly using the JW modifier

Last Modified: 4/17/2024 Location: FL Business: Part A

Avoid claim denials: Bill drug wastage correctly using the JW modifier

CMS encourages physicians to administer drugs to patients in such a way that they can use drugs or biological most efficiently.

The JW modifier is used on claims to show discarded unused drugs or biologicals from a single use vial or single use package. The modifier is not used on claims for multi-use vials or drugs paid under the Part B drug Competitive Acquisition Program (CAP). The modifier is also not intended for use on claims for hospital impatient admission that are billed under the Inpatient Prospective Payment System.

First Coast has seen appeal requests with denied drug lines because the wastage was not indicated. The JW modifier must be included so the claim processing system can accurately calculate the payment.

Payment and billing

Payment is allowed when a provider must discard a portion of a single use vial or other single use packages after administering a dose/quantity of the drug or biological to a Medicare patient. Providers must separately document in the patient's medical record the amount of drug or biological administered to the patient and the amount discarded.

Claims submitted that include drug wastage must be billed as two separate lines

• Line No. 1 represents the portion/dosage actually administered to the patient. Please remember to verify and convert to the proper billing units based on the code descriptor.

• Line No. 2 represents the discarded portion and is billed with the JW modifier.

For example: A single use vial that is labeled to contain 100mg of a drug has 95mg administered to the patient and 5mg discarded. The 95mg dose is billed on one line, while the discarded 5mg is billed on another line with the JW modifier. Both line items would process for payment because the vial held more units than what was used and the unused portion must be accounted for.

Claims submitted containing only the line with the JW modifier will be rejected for improper billing. Wastage is always billed in conjunction with the administered portion. The JW modifier is not used when the actual dose of the drug or biological administered is less than the billing unit.

For example: If 7mg were administered of a 10mg single use vial, and the 10mg represents 1 billing unit, the administered and discarded amounts cannot be split for billing purposes. Billing another unit on a separate line with the JW modifier for the discarded 3mg would result in an overpayment.

Sources:
CMS IOM Pub, 100-04 Medicare Claims Processing Manual, Chapter 17, section 40 external pdf file

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