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JW Modifier and Medicaid

  1. Smile JW Modifier and Medicaid
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    I am with an Oncology practice and we bill numerous medications. We have run in to a problem with Medicaid denying line items with the JW modifier: "MEDICAID DOES NOT RECOGNIZE ONE OR MORE OF THE BILLED MODIFIERS PLEASE CORRECT THE MODIFIER INFORMATION AND RESUBMIT. REFER TO YOUR MODIFIER MANUAL FOR ASSISTANCE IF NECESSARY". we have verified that this is a billable modifier and certainly have had zero problems with Medicare or any other carrier. Has anyone had this problem and if so, what has been your outcome? I appreciate any input anyone can provide.

    Michelle L.
    (soon to be CPC)

  2. #2
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    Tacoma, WA
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    Quote Originally Posted by MLambert1565 View Post
    I am with an Oncology practice and we bill numerous medications. We have run in to a problem with Medicaid denying line items with the JW modifier: "MEDICAID DOES NOT RECOGNIZE ONE OR MORE OF THE BILLED MODIFIERS PLEASE CORRECT THE MODIFIER INFORMATION AND RESUBMIT. REFER TO YOUR MODIFIER MANUAL FOR ASSISTANCE IF NECESSARY". we have verified that this is a billable modifier and certainly have had zero problems with Medicare or any other carrier. Has anyone had this problem and if so, what has been your outcome? I appreciate any input anyone can provide.

    Michelle L.
    (soon to be CPC)
    State Medicaid programs have their own set of guidelines and they don't necessarily follow Medicare or commercial payers. You need to go to the website for your Medicaid program and check for billing instructions for the meds you are using. This may not be a valid modifier for that program.
    Arlene J. Smith, CPC, CPMA, CEMC, COBGC

  3. Default
    Thank you Arlene. We have noticed though, that some have paid and some have not. I guess it's all about who is keying the claim. I feel we need to research a little more but thank you for the input.
    MLambert

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