Forum - Questions & Answers

Jun 12th, 2009 - JULIA7014 8 

Billing for left over medication

Is there a modifier or cpt code that can be used to describe that
we are billing for units of left over medication/to be discarded?
Thanks.

Jun 12th, 2009 - nmaguire   2,606 

Drug Wastage

Reference the Medicare Claims Processing Manual (Chapter 17 - "Drugs and Biologicals"), "if a physician, hospital or other provider must discard the remainder of a single use vial or other single use package after administering a dose/quantity of the drug or biological to a Medicare patient, the program provides payment for the amount of drug or biological discarded along with the amount administered, up to the amount of the drug or biological as indicated on the vial or package label."
CMS states local Carriers "may" use modifier 'JW' . Highmark Medicare Services, for example, does not. However, if you use the 'JW' modifier to identify unused drugs, that is fine. It's been left to FIs and MACs to set their own policy on documenting drug waste. Example: the drug Remicaid is prepared and billed in 100 mg increments. But it's not uncommon for it to be ordered as a 350 mg dose, you can bill for 400 mg, but you have to have the documentation of 350 mg administered and 50 mg wasted. The billing of drug waste is appropriate only to a single-use vial or single-use package.



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