How to use the JW modifier

A new CMS rule becomes effective Jan. 1, 2017. Providers are required to use the JW modifier on claims to report the unused portion of drugs or biologicals from single-use vials (or single-use packages) – which are appropriately discarded and noted in the patient’s chart.

For example, a single-use vial of a drug that contains 100 units has 95 units administered to the patient and 5 units discarded. The 95-unit dose is billed on one line and the 5 unit discarded dose is billed on a separate line with modifier JW. Both lines will be processed for payment.

This policy mandates that the discarded amount of drugs or biologics be recorded in your patient’s medical record.

Remember, this is effective Jan. 1. We wanted to notify you now to allow you time to make your billing staff aware and for you to get into the habit of making additional notations in patients’ charts. This does not apply to drugs which were provided under the Competitive Acquisition Program (CAP) for Part B drugs or biologicals from single-use vials.

Advocacy Issue: 
Billing, Coding & Payments