Nebraska Medicaid: Billing updates for JW modifier
Updates apply to acute care providers billing outpatient hospital claims through the EAPG payment methodology
Effective Oct. 1, 2023, Nebraska Medicaid will no longer reimburse for drugs that have been discarded, as indicated by being billed with the JW modifier (drug amount discarded/not administered to any patient).
This applies to acute care providers billing outpatient hospital claims through the enhanced ambulatory patient grouping (EAPG) payment methodology.
What this means for you
If a drug is billed twice on the same date of service with the same revenue code — once without the JW modifier and once with the JW modifier — the line with the JW modifier will not be paid, and payment will be consolidated to the unmodified drug line.
This will help support payment accuracy and eliminate duplicative payments for these services.
We’re here to help
Chat with a live advocate 7 a.m.–7 p.m. CT from the UnitedHealthcare Provider Portal. You can also contact UnitedHealthcare Provider Services at 866-331-2243, 7 a.m.–6 p.m. CT, Monday–Friday.