Medicare requires use of JW modifier for discarded drugs

Earlier this week, the Centers for Medicare and Medicaid (CMS), released guidance that the use of the JW modifier must be used when billing for discarded drugs for dates of service July 1, 2016 and later.  Medicare Administrative Contractors (MAC) have had latitude whether or not to require the use of this modifier, but that will no longer be the case – it will be required.  Additionally, CMS will require that the unused/discarded amounts be contained within the medical record.  You can link to CMS Transmittal R3530CP here.

Those of you who have been using JW for discarded drugs will likely see no changes other than recording the unused amounts in your medical record.

For those who have not been using JW for discarded drug amounts, expect guidance from your MAC in the near future.  The below is a common scenario (in this example, Botox® is the drug under consideration):

  • A patient is seen at the end of the day and requires an injection of Botox® (HCPCS code J0585) for a covered indication.
  • The surgeon uses 90 units on the patient in treating the covered disorder.
  • The Botox® vial that is opened for this patient contains 100 units, so 10 units will expire and be unusable.
  • The medical record shows the used and discarded amounts per the CMS Transmittal.
  • The claim for the drug should show two separate lines:
    • one line with J0585 and 90 units
    • a second line with J0585-JW and 10 units
    • The practice will be reimbursed for all 100 units.

As always, if you need assistance with new or changed CPT or HCPCS codes, proper modifier use, training on coding or documentation, desire a chart review, or want an evaluation of your current 2016 fees via a Fee Schedule Analysis, Corcoran Consulting Group can help.  Visit our website or call us to learn more.   (800) 399-6565


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