Description
This policy provides direction on drug wastage reimbursement and the use of the JW and JZ modifiers.
Description
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Discarded drug or biological
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The amount of a single-dose vial or package that remains after administration of a drug or biological.
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Single-dose vials
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Vials intended for administration by injection or infusion for use in a single patient for a single procedure. Manufacturer FDA approved label or package insert specifies vial as single dose.
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Multi-dose vials
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Vials are intended for administration by injection or infusion containing more than one medication dose. Manufacturer FDA approved label or package insert specifies vial as multi-dose. JW modifier should not be appended to multi-dose vials.
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JW Modifier
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Is used to report the drug amount discarded or not administered to any patient. This modifier should only be appended to drugs or biologicals that are single-dose vials or packages.
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JZ Modifier
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Is used to report there was zero drug amount discarded or not administered to any patient. This modifier should only be appended to drugs or biologicals that are single-dose vials or packages.
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Policy Application
All claims submitted for this policy will be processed according to the policy effective date and associated revision effective dates in effect on the date of service.
Policy
Reimbursement is eligible for single-dose drugs and biologicals reported with the JZ modifier as well as drug wastage on single-dose drugs and biologicals if reported on a separate line along with the JW modifier and the amount of wastage. Reimbursement will not be allowed on multi-dose drugs and biologicals. Eligible drug and biological services will be subject to the BCBSND fee schedule amount.
Note: BCBSND does not currently require the JZ modifier be appended to drugs or biologicals that are single-dose vials or packages.
The medical record must clearly document the exact dosage administered and the exact amount of the discarded portion of the drug or biological. Providers are expected to utilize the drug or biological in a responsible manner to avoid wastage.
Coding Guidelines
To be eligible for reimbursement, submit the single-dose drug or biological administration and wastage on one claim. List the single-dose drug or biological administration on one line and wastage on a separate line with the JW modifier appended.
Claim Line 1 – Administered
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Claim Line 2 - Wastage
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- HCPCS code
- No modifier
- Number of administered units
- Total charge for the administered drug or biological
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- HCPCS code
- JW modifier
- Number of wasted units
- Total charge for the drug wastage
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