This policy provides direction on drug wastage reimbursement and the use of the JW modifier.
Reimbursement is eligible for 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.
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.
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
Medicare Claims Processing Manual, Publication 100-04, Chapter 17, Section 100.2.9 – Regulation and Guidance
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.