HCPCS Modifier JW

Description:
Drug amount discarded/not administered to any patient

Guidelines/Instructions:
Effective January 1, 2017, contractors no longer have discretion to determine whether the JW HCPCS modifier is required for claims with discarded Part B drugs and biologicals.

  • Providers are required to:
    • Use the JW HCPCS modifier for claims with unused drugs or biologicals from single use vials or single use packages that are appropriately discarded (except those provided under the Competitive Acquisition Program (CAP) for Part B drugs and biologicals) and
    • Document the discarded drug or biological in the patient's medical record when submitting claims with unused Part B drugs or biologicals from single use vials or single use packages that are appropriately discarded
  • Use of the JW HCPCS modifier, billed on a separate line, will provide payment for the amount of the discarded drug or biological 
    • For example, a single use vial that is labeled to contain 100 units of a drug has 95 units administered to the patient and five units discarded. The 95 unit dose is billed on one line, while the discarded five units should be billed on another line by using the JW HCPCS modifier. Both line items would be processed for payment.
  • CMS encourages physicians to schedule patients in such a way that they can use drugs and biologicals most efficiently. However, if a physician must discard the remainder of a single use vial or other single use package after administering it to a Medicare patient, the program covers the amount of drug discarded along with the amount administered, up to the amount of the drug or biological as indicated on the vial or package label.
  • Note: The coverage of discarded drugs applies only to single use vials. Multi-use vials are not subject to payment for discarded amounts of drugs or biologicals.
  • HCPCS modifier JW may only be submitted with the amount of drug or biological that is discarded. Do not submit HCPCS modifier JW 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 10 mg of the drug in a single use vial. A 7 mg dose is administered to a patient while 3mg of the remaining drug is discarded. The 7 mg 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 10 mg of drug administered and discarded. Billing another unit on a separate line item with the JW HCPCS modifier for the discarded 3 mg 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, HCPCS modifier JW may not be submitted.
  • HCPCS modifier JW is not used on claims for CAP drugs 

References:

Contact Railroad Medicare

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Contact a specific Railroad Medicare department

Provider Contact Center: 888-355-9165

IVR: 877-288-7600

TTY: 877-715-6397

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