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Effective January 1, 2018, payment may be made for discarded injectable drugs or biologicals (a therapeutic substance, such as a vaccine or drug, derived from a living organism), if the following criteria are met:

• The drug or biological is supplied in a single-use vial or single-use package and the smallest vial size for the dose administered is used.

• The drug or biological is administered to the patient and any unused portion is discarded. A provider cannot bill for discarded drugs if none of the drug was administered to a patient (e.g., patient misses an appointment).

• The discarded drug or biological submitted is not used for another patient.

• The dose administered and waste amount is clearly documented in the patient’s medical record. If a dose is based on patient specific factors (weight, body surface area), the medical record must document current measurements and the actual dose administered to the patient.

• The drug or biological vial size used produces the least amount of waste.

• The provider should file the actual drug administered on one line of the claim with a separate line using modifier JW for the drug waste.

Example: An injectable drug is available in 100 mg and 150 mg single-use vials. Your patient needs 180 mg based on his weight.

The goal is for your patients to receive the prescribed amount of injectable drugs with the smallest amount of wastage possible. For this example, we recommend using two 100 mg vials because only 20 mg is discarded compared to 120 mgs if two 150 mg vials are used. If two 150 mg vials are used, only 20 mg of wastage will be reimbursed. You are responsible for the remaining 100 mg of excess drug wastage.

We will not reimburse for the following:

• Any pharmaceuticals that are not administered to a member and/or that are deemed contaminated, expired or considered waste due to spillage or breakage.

• Discarded drugs or biologicals from multi-use vials.

• Discarded drugs or biologicals if the National Drug Code is not present and accurate on the claim.

NOTE: Drug units should be billed in whole numbers and not fractional units. The JW modifier should not be used when the actual dose of the drug administered is less than the HCPCS billing unit. 

*The drug or biological was purchased by the provider or the provider's office and administered to the patient.