Pharmacy Question for the Week of April 10, 2017

Question:

Is modifier JW always required when a single-use vial drug is discarded?

Answer:

Use of the JW modifier is not permitted when the actual dose of the drug or biological administered is less than the HCPCS defined billing unit. In other words, when the HCPCS code unit of service (UOS) is equal to or greater than the total of the dose plus the discarded waste, the JW modifier is not applicable.

Take, for example, a HCPCS drug billing unit of 10 mg. A 6 mg dose is administered to the patient and 4 mg is discarded. The HCPCS defined UOS has not been exceeded. The administered dose plus discarded volume equals 10 mg. The claim would be processed with a single line item of one HCPCS unit and submitted for payment. Billing an additional unit on a separate line of the claim with the JW HCPCS modifier would result in overpayment.