How do we code and bill for adenosine when we do not use the entire vial on a Medicare patient? Also, does this policy apply to radiopharmaceuticals or for all single-use administered drugs and diagnostic or therapeutic radiopharmaceuticals?
Medicare only covers discarded drugs for single-use vials; multi-use vials are not subject to payment for discarded amounts of drugs. Since adenosine is supplied as a single-use vial, there are several scenarios regarding how to code and bill based on the vial used (60 mg or 90 mg) and the patient administered dose, which is based on the patient’s weight. Medicare encourages physicians to schedule patients in such a way that they can use drugs or radiopharmaceuticals most efficiently. However, if a physician must discard the remainder of a single-use vial, the Medicare program covers the amount of drug or radiopharmaceutical discarded/decayed/wasted along with the amount administered. Effective July 1, 2023, providers of separately paid drugs or radiopharmaceuticals from single-use administrations are now required to report the waste with the JW modifier or, if there is no waste, to report the JZ modifier. This is important for CMS tracking and for consistency across the Medicare Administrative Contractors (MACs).
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