The Centers for Medicare & Medicaid Services (CMS) is revising the policy for use of the JW modifier to more effectively identify and monitor billing and payment for discarded drugs and biologicals. The current policy allows Medicare Administrative Contractors (MACs) the discretion to determine whether to require the JW modifier for any claims with discarded drugs or biological, as well as the specific details regarding how the discarded drug or biological information should be documented.
Effective July 1, 2016, providers are required to:
- Use the JW modifier for claims with unused drugs or biologicals from single-use vials or single use packages that are appropriately discarded (except those provided under the Competitive Acquisition Program [CAP] for Part B drugs and biologicals) and
- Document the discarded drug or biological in the patient’s medical record when submitting claims with unused Part B drugs or biologicals from single-use vials or single-use packages that are appropriately discarded.