June 27th, 2017
In the past, some Medicare Administrative Contractors have required providers to report wasted drugs with modifier JW (Drug amount discarded/not administered to any patient). Use of the modifier was at the contractor’s discretion, and some contractors told providers not to report it. But effective January 1, 2017, all providers (hospitals, freestanding centers and physician offices) will be required to use modifier JW, and they will continue to be required to document the amount of discarded drug in the individual patient’s medical record. Medicare’s discarded drug policy is located in Chapter 17 of the Medicare Claims Processing Manual. Briefly, it states that when a provider administers part of a single-use vial or other single-use package to a Medicare patient, and the rest of the container must be discarded, Medicare will pay both for the amount that was administered and the amount that was discarded. Note that this policy applies only to single-use containers or single-use vials. If part of a multi-use container is discarded, the provider may bill only for the amount that was actually administered to the patient.
The provider must report the drug on the claim as two separate charges: one claim line for the amount administered (with no modifier), and one claim line for the discarded drug amount, with modifier JW. For example, code J9035 represents Avastin (bevacizumab): 1 unit per 10 mg. If a patient is given 980 mg from two 400 mg and two 100 mg single use vials (total 1000 mg), and the remainder of the last vial is discarded (20 mg), the provider should report the following:
J9035 x 98 units (administered 980 mg)
J9035-JW x 2 units (wasted 20 mg)
Remember to price each line appropriately as well; the charge for the drug administered + the charge for the drug amount wasted should equal the total dollar amount of drug billed. Providers will be paid for both claim lines; CMS simply wants to track the amount Medicare pays for wasted drugs. CMS states that modifier JW should not be used “if the billing unit is equal to or greater than the total actual dose and the amount discarded.” For example, 2 mcg of sincalide is administered to a patient from a 5 mcg single use vial, and the remainder is discarded. Sincalide is reported with code J2805 (Injection, sincalide, 5 micrograms). Since 1 unit of the code is equal to the total amount administered plus the amount discarded, the provider will report 1 unit of code J2805 and modifier JW will not be applied.