CMS Issues Change Request for Unused Portion of Drugs


CMS has issued a Change Request to alert providers and Medicare Administrative Contractors of a change in policy beginning January 1, 2017 (not July 2016 as previously stated) in regards to the drug amount discarded when treating a patient.

After the new year, providers are required to:

• Use a JW modifier for claims on the unused portions of drugs or biologics from single use vials or packages that are appropriately discarded. Example: 95 units of a 100 unit package are used, and 5 units are discarded. The 95 units are billed on one line and the 5 units are billed on another using the JW modifier. The exception is for those drugs provided under the Competitive Acquisition Program (CAP) for Part B drugs and biologicals.

• Document the discarded drug or biological in the patient’s medical record when submitting claims.

CMS is establishing this change to ensure the uniform use of the JW modifier for all claims with discarded units, but not CAP drugs and biologicals.

Practice staff should be aware of these changes in order to safeguard proper reimbursements. IQSS will continue to monitor for any updates and notify its practices.