Thou “Shall” Use Modifier JW

Thou “Shall” Use Modifier JW

Does your Medicare administrative contractor (MAC) require modifier JW Drug amount discarded/not administered to any patient on claims with discarded drugs or biologicals? Check your policy because, if it doesn’t now, it will soon.

MACs have until July 5, 2016, to implement a recent revision to the Medicare Claims Processing Manual, Chapter 17, Section 40, which requires the uniform use of modifier JW for all claims with discarded Part B drugs and biologicals.

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Current policy allows MACs the discretion to determine whether to require modifier JW. Most do not.

Time for Change

Effective July 1, 2016, Medicare policy requires all providers to use modifier JW for claims with unused drugs or biologicals from single-use vials or single-use packages that are appropriately discarded (except those provided under the Competitive Acquisition Program for Part B drugs and biologicals).

The Centers for Medicare & Medicaid Services provides this billing example in the revised policy:

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 shall be billed on another line with the JW modifier. Both line items would be processed for payment. Providers must record the discarded amounts of drugs and biologicals in the patient’s medical record. [Emphasis added to indicate policy change.]

Source: MLN Matters MM9603 Revised, May 24, 2016

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Renee Dustman

Renee Dustman

Renee Dustman is executive editor at AAPC. She has a Bachelor of Science degree in Journalism and a long history of writing just about anything for just about every kind of publication there is or ever has been. She’s also worked in production management for print media, and continues to dabble in graphic design.
Renee Dustman

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Renee Dustman is executive editor at AAPC. She has a Bachelor of Science degree in Journalism and a long history of writing just about anything for just about every kind of publication there is or ever has been. She’s also worked in production management for print media, and continues to dabble in graphic design.

5 Responses to “Thou “Shall” Use Modifier JW”

  1. Susan says:

    What if the Dr. uses all the drug? Do you still have to report a second line with the JW modifier and zero units?

  2. Vickey says:

    THis has been delayed to Jan 1 2017

  3. Sherry says:

    Do you have to bill for the discarded drugs?

  4. Will says:

    You don’t “bill” for the discarded drug. The whole point of this is to document that waste (extra drug) is being destroyed. Reimbursement occurs for the entire single dose vial when a dose is given to a single patient. The idea here is to prevent fraud. If the healthcare provider keeps the waste they could use it on other patients. The provider would be reimbursed for two vials in this case when in reality they split a single vial (or many vials).

  5. JENNIFER says:

    Can we use this for allergy patches? We had a patient come in and leave his apt before we were done due to time constraint and the patches were all discarded. I see package is listed for units in this article along with vials…

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