Drug & Biological Wastage

Policy ID: NDRP-GC-016

Section: General Coding

Effective Date: July 15, 2019

Revised Date: September 05, 2023

Last Reviewed: July 20, 2023

Applies To: Commercial and Medicaid Expansion

Description

This policy provides direction on drug wastage reimbursement and the use of the JW and JZ modifiers.

Description

Discarded drug or biological

The amount of a single-dose vial or package that remains after administration of a drug or biological.

Single-dose vials

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.

Multi-dose vials

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.

JW Modifier

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.

JZ Modifier

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.

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.

Claim Submission

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

Claim Line 2 - Wastage

HCPCS code
No modifier
Number of administered units
Total charge for the administered drug or biological

HCPCS code
JW modifier
Number of wasted units
Total charge for the drug wastage

Limitations & Exclusions

While reimbursement is considered, payment determination is subject to, but not limited to:

Group or Individual benefit
Provider Participation Agreement
Routine claim editing logic, including but not limited to incidental or mutually exclusive logic, payment integrity edits and medical necessity
Mandated or legislative required criteria will always supersede.

In instances where the provider is participating, based on member benefits, co-payment, coinsurance, and/or deductible shall apply.

Cross References

Medicare Claims Processing Manual

History

Date

Updates

8/27/2021

Updated policy to new format

7/1/2022

Policy reviewed

7/20/2023

Policy annual review completed and JZ modifier information added.

Disclaimer

Reimbursement policies are intended only to establish general guidelines for reimbursement under BCBSND plans. BCBSND retains the right to review and update its reimbursement policy guidelines at its sole discretion.

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