Discarded Drugs and Biologicals Policy, Professional and Facility Policy - Reimbursement Policy - UnitedHealthcare Commercial Plans
This policy describes reimbursement guidelines for appropriately reporting discarded drugs and biologicals, identified by modifier JW, administered from single use vials, single use packages, and multi-use vials. Providers may be reimbursed for discarded drugs and biologicals when appropriately reported based on the policy reimbursement guidelines.
All services described in this policy may be subject to additional UnitedHealthcare reimbursement policies including, but not limited to, the CCI Editing Policy and Maximum Frequency per Day.
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Questions and Answers
Q: Is the JW modifier required on single dose drug or biological when submitting a CPT/HCPCS code for the discarded portion.
A: In order for a discarded drug or biological to be considered for reimbursement, the modifier JW is required to be appended to the CPT/HCPCS code representing the discarded amount.
Q: Can a provider submit a claim for the discarded amount of a multi-dose vial (MDV) with modifier JW appended when they have used a partial vial of drug or biological?
A: No, it is not appropriate to append modifier JW to a multi-dose vial.
Q: Is the JW modifier applicable when the dose administered is less than the CPT/HCPCS billing unit?
A: No, The JW modifier is not applicable because fractional billing units should not be submitted.