Effective Jan. 1, 2017, you must include modifier -JW in Medicare claims submission for any discarded Part B drugs and biologicals from a single-use vial. Only Part B drugs and biologicals provided under the Competitive Acquisition Program are excepted from the requirement. The Centers for Medicare and Medicaid Services changed the requirement to create uniformity among Medicare Administrative Contractors.

How to Follow the New Requirement

1. Continue documenting any unused amount in the patient’s chart.
2. Submit the amount used for the patient on the first line item.
3. Include modifier -JW and the amount discarded on the second line item.
4. Do not bill on a separate line if the actual dose of the drug is less than the billing unit, since payment for the discard is included in the billing unit.

When to Use Modifier-JW

Example 1: J3300 Injection, triamcinolone acetonide, preservative free, 1mg

• Amount used: The patient received 4 units from a 40-unit vial.
• Wastage: 36 units.
• How to code: Append modifier -JW on the wasted units:
  J3300 4 units
  J3300 -JW 36 units

Example 2: J0585 Injection, OnabotulinumtoxinA, 1 unit

• Amount used: The patient receives 20 units from a 100-unit vial.
• Wastage: 80 units
• How to code: Append modifier -JW on the wasted units.
  J0585 20 units
  J0585 -JW 80 units

When Not to Use Modifier-JW

Example: J0178 Injection, aflibercept, 1mg

• One unit is up to 1mg. The appropriate dosage for Eylea is 2 units.
• Wastage: Less than 2 mg.
• How to code: Because of the appropriate dosage for Eylea, wastage less than 2mg does not require modifier -JW.

For more information, see the MLN Matters Article on the -JW modifier.