Wiki JW Waste

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I am not familiar with a percentage. Drug waste should be recorded and reported based on the HCPC unit of measure. Whether or not waste is billed on a separate line with JW modifier will be determined by the insurance drug waste policy.
 
I have never heard of a percentage on this. Where did you hear this?


Could someone have been referring to this? https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/clm104c17.pdf "A situation in which the JW modifier is not permitted is when the actual dose of the drug or biological administered is less than the billing unit. For example, one billing unit for a drug is equal to 10mg of the drug in a single use vial. A 7mg dose is administered to a patient while 3mg of the remaining drug is discarded. The 7mg dose is billed using one billing unit that represents 10mg on a single line item. The single line item of 1 unit would be processed for payment of the total 10mg of drug administered and discarded. Billing another unit on aseparate line item with the JW modifier for the discarded 3mg of drug is not permitted because it would result in overpayment. Therefore, when the billing unit is equal to or greater than the total actual dose and the amount discarded, the use of the JW modifier is not permitted. For dates of service beginning July 1,2023, the JZ modifier shall be used in this circumstance."
 
Agree with what others have already said. I've never heard of a percentage threshold on drug waste reporting in the 20 years I've been working in Oncology coding and billing.

With oncology drug authorizations, the payers will sometimes factor in a 10% "cushion" in the dose they approve to allow for small changes in weight based drugs. I'm wondering if you are confusing this with the billable amounts and drug waste reporting?
 
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