Medical Billing and Coding Healthcare Blog

The Centers for Medicare & Medicaid Services (CMS) has issued a change in policy regarding the use of the -JW modifier for discarded Part B drugs and biologicals.

The -JW modifier identifies "Drug amount discarded/Not administered to any patient."

Effective Jan. 1, 2017, providers will be required to:

  • use the -JW modifier for claims with unused drugs or biologicals from single-use vials or single-use packages that are appropriately discarded (except those provided under the Competitive Acquisition Program (CAP) for Part B drugs and biologicals); and
  • document the discarded drug or biological in the patient's medical record when submitting claims with unused Part B drugs or biologicals from single-use vials or single-use packages that are appropriately discarded

The -JW modifier is not used on claims for CAP drugs and biologicals.

CMS indicated it is revising this policy to require the uniform use of the -JW modifier for all claims with discarded Part B drugs and biologicals in order to more effectively identify and monitor medical billing and payment for discarded drugs and biologicals.

The American Society for Clinical Pathology (ASCP) recently shared its recommendation for pricing new laboratory tests with the Centers for Medicare & Medicaid Services (CMS).

The ASCP's recommended 2017 clinical laboratory billing rates can be viewed here.

They were outlined at a July meeting with CMS by ASCP Past President Dr. Lee Hilborne.

The recommendations covered a series of new molecular assays, genomic sequencing procedures and other CPT codes added to the Medicare Clinical Laboratory Fee Schedule. As ASCP notes,  many of its recommendations focused on crosswalking the new tests or revised CPT codes to existing tests that require similar resources and are technologically similar.

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