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March 11, 2015

HCPCS Modifier JW Billing/Coding Guidelines

CGS does not require the use of HCPCS modifier JW to indicate drug wastage of a single dose vial/packaged drugs and biologicals. However, providers may voluntarily continue to use HCPCS modifier JW when appropriate.

You may submit HCPCS modifier JW if an unused portion of the drug/biological is appropriately discarded. HCPCS modifier JW, billed on a separate line, will provide payment for the amount of discarded drug or biological.

Example: a single use vial that is labeled to contain 100 units of a drug

95 units out of the 100 unit vial is administered to the patient
- The 95 unit dose is billed on one line.
5 units out of the 100 unit vial is discarded
- The discarded 5 units may be billed on another line using HCPCS modifier JW.
Both line items would be processed for payment.

To submit a claim for drug waste reimbursement, providers must report two claim lines per wasted drug as outlined in the following example:

Claim line 1 - provide the following information:

HCPCS code for drug administered
No modifier
Number of units administered to the patient
Calculated submitted price for only the amount of drug given

Claim line 2 - provide the following information:

HCPCS code for the drug wasted
HCPCS modifier JW to indicate wastage
Number of units wasted
Calculated submitted price for only the amount of drug wasted
You may elect to decline reimbursement for the wasted drug amount. In this situation, submit a claim for only the drug amount administered to the patient.

Note: When the billing units are equal to or greater than the total actual dose and the amount discarded, HCPCS modifier JW may not be submitted.

Example: One billing unit for a drug is equal to 10 mg of the drug in a single use vial.

A 7 mg dose is administered to a patient.
3 mg of the remaining drug is discarded.
The 7 mg dose is billed using one billing unit that represents 10 mg on a single line item. The single line item of 1 unit would be processed for payment of the total 10 mg of drug administered and discarded.
Billing another unit on a separate line item with HCPCS modifier JW for the discarded 3 mg of drug is not permitted because it would result in overpayment.

Reference: CMS Medicare Claims Processing Manual (Pub. 100-04), chapter 17, section 40

Medical Record Documentation

It is the provider's responsibility to include concise documentation in the medical record for all services rendered. Therefore, whether or not you choose to report drug wastage with HCPCS modifier JW on your claim, you are required to include documentation of the amount of the drug administered and wasted in the medical record.

While CGS does not provide specific guidance on the documentation of wastage, we advise providers to include anything they feel would help clearly document the amount of the single use vial that was administered and the amount that was wasted in case of a review of patient records.