Documentation of Discarded Drugs
As described in Chapter 17, Section 40.1 of the Medicare Claims Processing Manual, in addition to paying for the amount of the drug that has been administered to a beneficiary, Medicare Part B also pays for the amount of drug that has been discarded, up to the amount that is indicated on the vial or package label. The discarded drug amount is the amount of a single use vial or other single use package that remains after administering a dose/quantity of the drug to a Medicare beneficiary.
Effective January 1, 2017, providers and suppliers are required to report the JW modifier on Part B drug claims for discarded drugs and biologicals. Also, providers and suppliers must document the amount of discarded drugs or biologicals in Medicare beneficiaries’ medical records.
The JW modifier is a Healthcare Common Procedure Coding System (HCPCS) Level II modifier used on a Medicare Part B drug claim to report the amount of the drug or biological (drug) that is discarded and eligible for payment under the discarded drug policy. The modifier should only be used for drugs in single dose or single use packaging. CMS does not use fractional billing units to pay for Part B drugs. Therefore, the JW modifier should not be used when the actual dose of the drug administered is less than the HCPCS billing unit.
The drug discarded should be billed on a separate line with the JW modifier. The unit field should reflect the amount of drug discarded. Please refer to the example in the Medicare Claims Processing Manual Chapter 17, Section 40.
References
Centers for Medicare and Medicaid (CMS). MLN Matters MM9603; https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM9603.pdf; Published June 9, 2016. Accessed July 22, 2019.
Centers for Medicare and Medicaid (CMS). Medicare Program JW Modifier: Drug/Biological Amount Discarded/Not Administered To Any Patient Frequently Asked Questions; https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalOutpatientPPS/Downloads/JW-Modifier-FAQs.pdf; Published August 26, 2016. Accessed July 22, 2019.