Wiki j9260 methotrexate

[Korbc]

does anyone know if this is a drug that you can charge for the discarded amount for with the JW modifier. CMS's verbiage on their website was a bit confusing

 

[nielynco]

does anyone know if this is a drug that you can charge for the discarded amount for with the JW modifier. CMS's verbiage on their website was a bit confusing

There is an AAPC article on this: https://www.aapc.com/blog/88325-master-modifiers-jw-and-jz-rules/

 

[Korbc]

There is an AAPC article on this: https://www.aapc.com/blog/88325-master-modifiers-jw-and-jz-rules/

thanks a ton! and do some insurance carriers honor this do you know or is jw and jz specifically only for medicare?

 

[CBLENNIE]

thanks a ton! and do some insurance carriers honor this do you know or is jw and jz specifically only for medicare?

It should be required for any Medicare Advantage (MA) plans, but on commercial plans, the required use of the modifiers JW & JZ it is going to be carrier specific. The commercial carrier I work for requires them, but I know others don't. The best recommendation is to check with the carriers you contract with and make a list of who does and does not require these modifiers.

 

[trarut]

My reference sheet shows methotrexate is available in both single dose and multi dose vials so it is possible you would need to bill it using a JZ or JW modifier, depending on your payer requirements. In my experience, the payers have policies directly addressing the use of the JZ/JW modifiers. And all the Medicare Advantage plans we work with require as does Medicare (obviously ). In our area, only two of the "big payers" don't require the waste modifiers.

 

[Korbc]

It should be required for any Medicare Advantage (MA) plans, but on commercial plans, the required use of the modifiers JW & JZ it is going to be carrier specific. The commercial carrier I work for requires them, but I know others don't. The best recommendation is to check with the carriers you contract with and make a list of who does and does not require these modifiers.

thank you so much!

 

[Korbc]

My reference sheet shows methotrexate is available in both single dose and multi dose vials so it is possible you would need to bill it using a JZ or JW modifier, depending on your payer requirements. In my experience, the payers have policies directly addressing the use of the JZ/JW modifiers. And all the Medicare Advantage plans we work with require as does Medicare (obviously ). In our area, only two of the "big payers" don't require the waste modifiers.

thanks so much!

 

[Korbc]

hey guys
if 2.2ml of j9260 was administered i believe guidance since it would then be 3 units because the .2ml is rounded up to another unit, and then no waste is reported or another j9260 with the amount of waste. I know waste is payer dependent but if you seeing if that would even apply to this code i guess or situation since it says just to bill another full unit for it?

thanks!