"Billing Examples Using JW Modifier
Per-Unit Example, Multiple Patients:
A physician schedules three Medicare patients to receive botulinum toxin type A (J0585, botulinum toxin type A, per unit) on the same day within the designated shelf life of the product. Currently, Botox┬« is available only in a 100-unit size. Once Botox┬« is reconstituted in the physician’s office, it has a shelf life of only four hours. Often, a patient receives less than a 100-unit dose. The physician administers 30 units to each patient. Your claim for these patients would indicate J0585 billed at quantity 30 (to indicate the amount administered to the patient). Billing J0585 JW is not appropriate for these patients.
Your claim for the last patient receiving Botox┬« in those four hours is where the remaining 10 units are to be billed to Medicare. Your last patient’s claim would indicate J0585 billed at quantity 30 (to indicate the amount administered to the patient) on one detail line. The next detail line would indicate J0585 JW billed at quantity 10 (to indicate the 10 units wasted from the 100-unit vial).
Per-Unit Example, Single Patient:
A physician must administer 15 units of Botox┬« to a Medicare patient, and it is not practical to schedule another patient who requires Botox┬«. For example, the physician has only one patient who requires Botox┬« or when the physician sees the patient for the first time and did not know the patient’s condition.
Your claim for this patient would indicate J0585 billed at quantity 15 (to indicate the amount administered to the patient) on one detail line. The next detail line would indicate J0585 JW billed at quantity 85 (to indicate the 85 units wasted from the 100-unit vial).
Note in both of the above examples the entire 100 units that were an expense to the billing provider are accounted for with the combination of the drug code on one detail line and the JW wastage on the next detail line. The code description for J0585 is billed in this manner because the billing unit (HCPCS description) does not indicate an entire 100-unit vial but a breakdown by units of the vial."
Hope that helps!
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