New Policy on JW Modifier
Effective January 1, 2017, the use of the JW modifier is required for claims with unused drugs or biologicals from single use vials or single use packages that are appropriately discarded. Providers are required to document the discarded drug or biological in the patient’s medical record. The JW modifier is only applied to the amount of drug or biological that is discarded. The JW modifier is not required for drugs that are not separately payable, such as packaged Outpatient Prospective Payment System (OPPS) drugs or drugs administered in the Federally Qualified Health Center (FQHC) or Rural Health Clinic (RHC) setting, or drugs paid under the Part B Drug Competitive Acquisition Program (CAP). The JW modifier is not intended for use on claims for hospital inpatient admissions that are billed under the Inpatient Prospective Payment System.
NOTE: Multi-use vials are not subject to payment for discarded amounts of drug or biological.
JW Modifier Definition and Usage
JW modifier is a Healthcare Common Procedure Coding System (HCPCS) Level II modifier used on a Medicare Part B drug claim to report the amount of drug or biological that is discarded and eligible for payment under the discarded drug policy.
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.
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.
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. Please remember to verify the milligrams given to the patient and then convert to the proper units for billing based on the codes descriptor. Example of payment provided for the amount of discarded drug or biological:
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.
Medicare record must clearly indicate the number of units administered and amount discarded.
Billing Example Without Using JW Modifier
JW modifier is not permitted when the actual dose of the drug or biological administered is less than the HCPCS billing unit. Example when JW modifier is not permitted:
One billing unit for a drug is equal to 10mg of the drug in a single use vial.
7mg dose is administered to the patient while 3mg of remaining drug is discarded.
7mg dose is billed using one billing unit that represents 10mg on a single line item.
Single line item of one (1) unit would be processed for payment of total 10mg of drug administered and discarded.
Billing another unit on a separate line item with the JW modifier for the discarded 3mg of drug is not permitted because it would result in over-payment.
Medicare Learning Network Matters Article, MM 9603 JW Modifier: Drug Amount Discarded/Not Administered to any Patient
Medicare Program JW Modifier: Drug/Biological Amount Discarded/Not Administered To Any Patient Frequently Asked Questions
Medicare Claims Processing Manual, Publication 100-04, Chapter 17, Section 40 Drugs and Biologicals