Rituximab is available in single-use vials of 100 mg/10 mL and 500 mg/50 mL. The CPT/HCPCS code and description for rituximab is J9312, rituximab 10mg. If 750 mg of rituximab is administered, it is appropriate to bill for 75 units J9312 because the CPT/HCPCS code J9312 defines the unit for rituximab as 10mg. If 800 mg total are utilized, but only 750 mg are administered, then 50 mg are wasted and documented in the medical record. Because the administered amount requires billing 75 units of J9312, 50 mg of wastage is billed on a separate service line as five units of J9312, along with the JW modifier, that is not utilized.
Example #2
J1745 is the CPT/HCPCS code for infliximab 10 mg, but the drug is sold as 100 mg of lyophilized infliximab in a 20 ml vial. If the patient received 360 mg of infliximab, the correct way to bill this is J1745 x 36 (36 x 10 = 360 mg); four units were wasted, so 40 mg would have to be documented as drug wastage and coded with the JW modifier to indicate drug wastage.
Additional Reminders
Providers are responsible for submission of accurate documentation of services performed and are expected to submit claims for services rendered using valid CPT/HCPCS code combinations. Documentation is expected to be maintained in the patient’s medical record and be made available to payers upon request. The medical record should include the name of the drug, dosage, route of administration and time and date given. When a portion of the drug is discarded, the medical record must clearly document the amount administered and the amount wasted.
Keep in mind, although the JW modifier was created by the CMS, its use is not limited to CMS members or plans. Practices will need to verify with payers their policy and guidelines for drug wastage because every reimbursement type is determined by the patient’s plan and covered services.
For questions on drug wastage or additional information on coding and documentation guidelines, contact the ACR practice management department at [email protected]. For additional information on drug wastage guidelines, refer to CMS Medicare Claims Processing Manual, Chapter 17, Drugs and Biologicals.
Table: Billing Drug Wastage Do’s & Don’ts
| Do’s | Don’ts |
| Refer to your CMS contractor to verify appropriate billing of discarded drugs. | Do not use the JW modifier when the billing unit is equal to or greater than the total actual dose and the amount discarded. For example, if one billing unit is equal to 10 mg and 7 mg of a drug was administered to a patient and 3 mg of the drug was discarded, the JW modifier cannot be used to report the discarded drug because the sum of the administered dose (7 mg) and the discarded dose (3 mg) is equal to the billing unit of 10 mg. |