Melisa Posted Mon 04th of April, 2011 16:37:37 PM
Is the JW modifier a required modifier if you are wasting a drug? I was under the impression it was not required by CMS yet but BCBS of TN guidelines it is required. Can their "rules" be different than CMS? Thanks for any help you can give me.
SuperCoder Answered Mon 04th of April, 2011 20:30:05 PM
JW Drug amount discarded/not administered to any patient:
Medicare will cover the amount of the drug that is reasonable and necessary for the patient's condition. If a physician must discard the remainder of a vial after administering a portion to a Medicare patient, the Medicare program may cover a small, but reasonable amount of discarded drug, along with the amount administered. Medicare expects this wastage to be minimal. The provider should make an effort to schedule patients in such a way that they can minimize any waste and use the drug most efficiently.
The JW modifier, billed on a separate line, will provide 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 five units discarded. The 95-unit dose is billed on one line, while the discarded five units may be billed on another line by using 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. Any amount wasted must be clearly documented in the chart with the time, amount of medication wasted and the reason for the wastage.
The JW modifier is not used on claims for CAP drugs.
See Pub. 100-04, Medicare Claims Processing Manual, Chapter 17, Section 40, for additional information on discarded drugs and biologicals.