This policy provides direction on drug wastage reimbursement and the use of the JW modifier.
- 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.
- 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.
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
Limitations and 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, 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.
Medicare Claims Processing Manual, Publication 100-04, Chapter 17, Section 100.2.9