Blue Cross follows CMS guidelines for use of JW modifier to indicate drug waste

As a reminder, Blue Cross Blue Shield of Michigan follows the Centers for Medicare & Medicaid Services’ standard billing guidelines for the use of the JW modifier to identify unused drugs or biologicals from single-use vials or single-use packages that are appropriately discarded. (Multiuse vials aren’t subject to payment for discarded amounts of drug.) This applies to professional claims only.

The JW modifier, billed on a separate line, will provide payment for the amount of the discarded drug or biological.

Example: A single-use vial that is labeled to contain 100 units of a drug has 95 units administered to the patient and five units discarded. The 95 unit dose is billed on one line, while the discarded five units will be billed on another line by using the JW modifier. Both line items would be processed for payment. Providers must record the discarded amounts of drugs and biologicals in the patient’s medical record.

Beginning in the fourth quarter of this year, some drug wastage will be reimbursed at a reduced rate for Blue Cross commercial. Refer to future minimum fee schedule for details.

For more information, check out the CMS article “Billing and Coding: JW Modifier Billing Guidelines.”**

**Blue Cross Blue Shield of Michigan doesn’t own or control this website.