| West Virginia Oncology Society |
HCPCS modifier JW will be required with CMS Change Request 671, which is effective on July 30,
2010. However, use of this modifier won't always require 2 separate claim lines. The next section
explains this in more detail - read on:
When we posted CMS's MLN Matters article MM6711, we added the following paragraph:
Note from Palmetto GBA: IOM Publication 100-4, Chapter 17, Section 40: "The JW modifier is only
applied to the amount of drug or biological that is discarded. A situation in which the JW modifier is
not permitted is when the actual dose of the drug or biological administered is less than the billing
unit. For example, one billing unit for a drug is equal to 10 mg of the drug in a single use vial. A 7
mg dose is administered to a patient while 3 mg of the remaining drug is discarded. The 7 mg dose
is billed using one billing unit that represents 10 mg on a single line item. The single line item of 1
unit would be processed for payment of the total 10 mg of drug administered and discarded.
Billing another unit on a separate line item with the JW modifier for the discarded 3 mg of drug is
not permitted because it would result in overpayment. Therefore, when the billing unit is equal to
or greater than the total actual dose and the amount discarded, the use of the JW modifier is not
permitted."
2010. However, use of this modifier won't always require 2 separate claim lines. The next section
explains this in more detail - read on:
When we posted CMS's MLN Matters article MM6711, we added the following paragraph:
Note from Palmetto GBA: IOM Publication 100-4, Chapter 17, Section 40: "The JW modifier is only
applied to the amount of drug or biological that is discarded. A situation in which the JW modifier is
not permitted is when the actual dose of the drug or biological administered is less than the billing
unit. For example, one billing unit for a drug is equal to 10 mg of the drug in a single use vial. A 7
mg dose is administered to a patient while 3 mg of the remaining drug is discarded. The 7 mg dose
is billed using one billing unit that represents 10 mg on a single line item. The single line item of 1
unit would be processed for payment of the total 10 mg of drug administered and discarded.
Billing another unit on a separate line item with the JW modifier for the discarded 3 mg of drug is
not permitted because it would result in overpayment. Therefore, when the billing unit is equal to
or greater than the total actual dose and the amount discarded, the use of the JW modifier is not
permitted."
| Clarification on Use of HCPCS Modifier JW from Manager of Provider Outreach & Education Palmetto GBA |
Advocacy & Reimbursement - Private Practice