Q&A: Are CAHs Required to Use Modifier -JW?

Q: We are a critical access hospital and don’t get paid under the OPPS. We get reimbursed based on our cost of procedures, tests and services. Is modifier –JW (drug amount discarded/not administered to any patient) applicable to us beginning in January?

A: The -JW modifier is applicable to all providers and supplies who bill Part B drugs to the Medicare program. The intent of the modifier is for CMS to be able to track the amount of medication that is discarded or “wasted” when doses are prepared for administration, as the Medicare program does provide reimbursement for discarded drugs in certain circumstances.

This modifier applies only to separately payable drugs that are supplied and purchased in single-use vials. This does not apply to every drug that is administered. The Medicare program provides reimbursement for the amount of medication that is not administered to any patient when the drug is packaged in a single-use vial. CMS notes in their guidance that it expects providers to schedule patients in a manner that allows best use of the medications, but they do realize that providers may not always be able to prevent discarding of medications (see Medicare Claims Processing Manual, Chapter 17, section 40).

For more information, see CMS’ modifier –JW FAQ document.

Editor’s note: Denise Williams, RN, CPC-H, senior vice president of revenue integrity services at Revant Solutions, in Fort Lauderdale, Florida, answered this question.

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