The JW Modifier is Only Applied to the Amount of Drug or Biological that is Discarded

by  Christine Woolstenhulme, QCC, QMCS, CPC, CMRS
October 19th, 2015

According to CMS, local contractors may require the use of the modifier JW to identify unused drug or biologicals from single use vials or single use packages that are appropriately discarded. This modifier, billed on a separate line, will provide payment for the amount of discarded drug or biological.

For example, a single use vial that is labeled to contain 100 units of a drug has 95 units administered to the patient and 5 units discarded. The 95 unit dose is billed on one line, while the discarded 5 units may be billed on another line by using the JW modifier. Both line items would be processed for payment.

The JW modifier is not permitted is when the actual dose of the drug or biological administered is less than the billing unit.

For example, one billing unit for a drug is equal to 10mg of the drug in a single use vial. A 7mg dose is administered to a patient while 3mg of the remaining drug is discarded. The 7mg dose is billed using one billing unit that represents 10mg on a single line item. The single line item of 1 unit would be processed for payment of the total 10mg of drug administered and discarded.

Billing another unit on a separate line item with the JW modifier for the discarded 3mg of drug is not permitted because it would result in overpayment. Therefore, when the billing unit is equal to or greater than the total actual dose and the amount discarded, the use of the JW modifier is not permitted.

The JW modifier is not used on claims for CAP drugs.

References:

The JW Modifier is Only Applied to the Amount of Drug or Biological that is Discarded. (2015, October 19). Find-A-Code Articles. Retrieved from https://www.findacode.com/articles/the-jw-modifier-is-only-applied-to-the-amount-of-drug-or-biological-that-is-discarded-31629.html

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