The JW modifier is a Healthcare Common Procedure Coding System (HCPCS) Level II modifier used on a Medicare Part B claim to report the amount of drug or biological that is discarded and eligible for payment under the discarded drug policy.
Definition and Usage
When a provider must discard the remainder of a single use vial or other single use package after administering a dose/quantity of the drug or biological to a Medicare patient, the Medicare Part B program provides payment for the amount of drug or biological discarded as well as the dose administered, up to amount of the drug or biological as indicated on the vial or package label.
Billing Example Using JW Modifier
The JW modifier is only applied to amount of drug or biological that is discarded. The discarded drug should be billed on a separate line with the JW modifier.
Claim Line #1 – HCPCS code for drug given
Claim Line #2 – HCPCS code for drug wasted
Billing Example #1 – Drug
A single-use vial is labeled to contain 100mg/4mL.
The code long descriptor indicates one (1) billing unit represents 10mg.
90mg are administered to the patient and 10mg are discarded.
The 90mg administered is billed as nine (9) units on one line, while the discarded 10mg are billed as one (1) unit on another line with the JW modifier.
Both line items would be processed for payment.
Medical record must clearly indicate the number of units administered and amount discarded.
Example #2 – Biological
A particular skin substitute comes in a 1-sq-cm piece
A total of 44-sq-cm is placed on a wound
The JW modifier is not permitted when the actual dose of the drug or biological administered is less than the HCPCS billing unit.
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 resulting in 3mg remaining drug being discarded
The 7mg dose is billed using one unit of service that represents 10mg on a single line item.
The single line item would be processed for payment of the total 10mg of the drug administered and discarded.
Billing another unit on a separate line item with the JW modifier for the discarded 3mg of the drug is not permitted because it would result in an overpayment.
Therefore, when the billing unit is equal or greater than the total actual dose and the amount discarded, the use of the JW modifier is not permitted.
The Centers for Medicare & Medicaid Services (CMS) encourages physicians, hospitals and other providers and suppliers to care for and administer to patients in such a way that they can use drugs or biologicals most efficiently.