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The purpose of this policy is to provide billing guidelines for reporting drug wastage to Blue Cross & Blue Shield of Mississippi (BCBSMS). Drug wastage is defined as medication that is discarded and not administered to any patient. Providers should utilize drugs in an efficient and proper manner based on clinical and medical standards to prevent drug wastage. However, when necessary to report drug wastage, modifier JW (Drug amount discarded/not administered to any patient) is appended to the applicable CPT/HCPCS drug code to identify the amount of drug wastage.
Definitions
Single-use vial - A drug vial of medication that is intended to be for use on a single patient for a single injection/infusion/procedure/case.
Multi-use vial - A drug vial of medication that contains more than one dose of medication that may be administered to a single patient or multiple patients.
Effective, January 1, 2023, BCBSMS will require ‘JW’ modifier to be appended to CPT/HCPCS drug codes to identify drug wastage reported on both professional (CMS-1500 and 837P) and facility (UB-04 and 837I) claim forms. To report drug wastage to BCBSMS, the drug should be reported as two separate line items on the claim(s).
Modifier -JW should be appended to the appropriate CPT/HCPCS code(s) for both a single-use vial and/or multi-use vial. Any amount of drugs billed as wastage, must actually be discarded and may not be used for another patient. The actual dosage administered, in addition to, the exact amount wasted and the total amount of the vial label contained, must clearly be documented in the patient’s medical records.
Medically Unlikely Edits (MUEs) will continue to be applicable to CPT/HCPCS codes when the maximum units of service for the drug code is exceeded. The appropriate CPT modifiers (e.g. 59) should continue to be appended and reported on either the same line or as a separate line item. Refer to ‘Multiple Units on the Same Day’ Coding Policy.
Following are two examples to illustrate the proper billing of drug wastage to BCBSMS:
Example 1: A 130 mg of Herceptin (HCPCS Code J9355) is administered to a patient from a single 150 mg dose vial. HCPCS code J9355 (Injection, trastuzumab, 10 mg) is reported per 10 mg.
Line 1: J9355 with 13 units
Line 2: J9355-JW with 2 units (20 mg discarded and not administered to the patient).
Example 2: A 420 mg multi-dose vial of Herceptin (HCPCS Code J9355), is administered to three (3) different patients. The first two patients are administered 140 mg each, and the last patient is administered 130 mg. HCPCS code J9355 (Injection, trastuzumab, 10 mg) is reported per 10 mg.
Patient 1:
Line 1: J9355 with 14 units
Line 2: Not applicable
Patient 2:
Line 1: J9355 with 14 units
Line 2: Not applicable
Patient 3:
Line 1: J9355 with 13 units
Line 2: J9355-JW with 1 unit (Note: 10 mg is discarded and not administered to any other patient.)
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01/01/2023: New policy added.
Medicare Program JW Modifier: Drug/Biological Amount Discarded/Not Administered To Any Patient Frequently Asked Questions
2019 HCPCS Manual
2022 HCPCS Manual
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