Pharmacy Question for the Week of February 6, 2017

Question:

Can you provide guidelines for billing drugs with the modifier JW?

Answer:

It’s important to remember that modifier JW applies only to single-use vials, which the Centers for Medicare & Medicaid Services define as a vial of liquid medication intended for parenteral administration (injection or infusion) that is meant for use in a single patient for a single case, procedure or injection.

In terms of billing, here’s an 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.

In addition to documenting the amount of drug wasted, the provider must document the amount administered in Medicare beneficiaries’ medical records. Medicare contractors no longer have the discretion to determine the modifier usage.