Did you know that you can even claim the insurance payer for a wasted drug? That’s right. Now, with the JW modifier, it is possible to calculate drug wastage, specify it on the claim form, and get reimbursed for it. Sounds fascinating, doesn’t it?
So, continue reading our detailed guide on modifier JW and learn how you can use this two-digit code to collect payment for the portion of the drug that you were forced to discard.
JW Modifier – Description
The Healthcare Common Procedure Coding System (HCPCS) Level II modifier, JW, indicates the amount of drug or biologic that was discarded or not administered to the patient. It is appended to the product code on the claim form. Moreover, you must ensure that the claim is being submitted for single-dose container drugs.
According to the Centers for Medicare and Medicaid Services (CMS), the JW modifier became effective on January 1, 2017. The application of this modifier became necessary for all Medicare Part B claims filed for drugs and biologicals, where some amount of the substance remained unused or was discarded. Modifiers JW and JZ were introduced together and are part of the same set. However, both serve different purposes, as explained below:
- Modifier JW: Denotes the discarded portion of the drug or biological.
- Modifier JZ: Zero drug amount was discarded, or the drug was NOT administered to any patient.
JW Modifier – Usage Examples
Still confused. Don’t worry. Practical examples always help when one seeks further clarity on a modifier’s usage. So, to help you out, below are some scenarios that underscore the JW modifier’s correct application. Take a look.
Discarding 10 mg of Avastin
For our first example, suppose that a patient with colorectal cancer visits his oncologist for a routine treatment session, where he is intravenously injected with 90 mg Avastin (generic name: bevacizumab), a monoclonal antibody, to block a protein called vascular endothelial growth factor (VEGF) and prevent abnormal growth of blood vessels.
The prescription drug comes in a 100 mg/ 4 mL single-use vial, and the instructions on the box specifically state “Discard unused portion”. So, after administering 90 mg of Avastin to the patient, the physician discards the remaining 10 mg in the vial. For billing purposes, the physician reports 9 units of the product with code J9035 on one claim line, and 1 unit of the same product with code J9035 and the JW modifier on another claim line.
So, the coding will be as follows:
| Date of Service | Place of Service | Units Billed | CPT/HCPCS | Modifier |
|---|---|---|---|---|
| 5/12/2025 | 11 | 9 | J9035 | |
| 5/12/2025 | 11 | 1 | J9035 | JW |
*The format may vary from claim form to claim form. 1 unit represents 10 mg of Avastin.
Discarding 45 Units of Botox
Now, imagine that a 45-year-old woman with chronic migraine visits her physician complaining of intense headaches that last several days. This also leads to dizziness, nausea, blind spots, and stiffness in the neck. Her physician administers 155 units of Botox (generic name: onabotulinumtoxinA), spread across 31 injections, in the specific head and neck muscles to act as a relaxant and reduce pain and migraine frequency. Each injection contains 5 units (0.1 mL) of Botox.
However, the single-dose Botox vial contains 200 units of powder for injection. The physician administers 155 units of it intramuscularly and discards the rest to avoid contamination. For billing, the physician will report 155 units of J0585 on the first claim line without the JW modifier and another 45 units of J0585 on the second claim line with the modifier.
Therefore, the coding will be as follows:
| Date of Service | Place of Service | Units Billed | CPT/HCPCS | Modifier |
|---|---|---|---|---|
| 20/12/2025 | 11 | 155 | J0585 | |
| 20/12/2025 | 11 | 45 | J0585 | JW |
HCPCS code J0585 is the product code for 1 unit of onabotulinumtoxinA (Botox) injection. Also note that most insurance payers do not cover Botox if it is administered for aesthetic or cosmetic reasons, such as to smooth facial wrinkles.
Accurate Usage Guidelines for the JW Modifier
The following are some of the dos and don’ts that you must keep in mind when appending the modifier JW to your product codes.
Use for Single-Use Drugs
You should not use the JW modifier if the drug was in a multiple-dose container. This is because there is no need to discard a drug that comes in a multiple-use packaging. The container can be opened and sealed several times without the risk of contamination. JW is appended only to drugs or biologicals that have an FDA-approved single-use labeling because these do not contain preservatives.
Append to the Product Code
You should append the JW modifier to the HCPCS product code and not the procedural code for drug administration.
Append on the Same Claim Line as the Amount Discarded
Another point to remember is that the JW modifier is appended to the second claim line, or the line where you have specified the amount/units of the discarded drug. For more clarity on this, re-read the ‘JW Modifier – Usage Examples’ section and see how the drugs were coded.
Specify the Setting and its POS Code
Any healthcare provider or supplier who purchases and bills separately payable drugs can use the modifier JW for coding specificity. Hence, the JW modifier is typically used in settings such as a physician’s office and hospitals’ outpatient units. So, to ensure that you are filing clean and complete claims on the first attempt, you must include the corresponding place of service (POS) code. For example, the POS code for a physician’s office is 11, and for an off-campus outpatient hospital is 19.
Do Not Use for Non-Renal Dialysis Service Drugs
Insurance payers allow you to use the JW modifier if a drug from a single-use vial was administered in an end-stage renal disease (ESRD) facility for the treatment of ESRD. However, the modifier is inapplicable if non-renal dialysis service drugs and biological products were discarded and reported for an ESRD facility claim. This is because for non-renal dialysis service drugs and biological products, modifier AY is used.
Do Not Use for RHC, FQHC, and IPPS
Payers also do not allow the use of the JW modifier on claims that were filed for drugs administered in a Federally Qualified Health Center (FQHC) or Rural Health Clinic (RHC). The reasoning for this is that any drug administered at these settings is not separately billable. The patient’s entire visit is billed as a whole, and the payer reimburses the provider at an all-inclusive rate.
Also, modifier JW should not be reported on hospital inpatient claims because the patient’s admission and any drug administration during the stay are billed under the Inpatient Prospective Payment System (IPPS).
Do Not Use When Dose Administered is Less than the Billing Unit
The last, but one of the most vital billing tips to pay heed to is that you must not use the JW modifier if the administered dosage of the drug was less than the billing unit specified in the HCPCS code.
For example, the HCPCS product code for a single-use drug specifies that you can bill 1 unit for every 10 mg of the drug injected into the patient. However, the provider only administers 7 mg and discards the remaining 3 mg. Now, he can report 1 unit of the HCPCS code to get reimbursement for the 7 mg of the drug used. However, he cannot report another unit of the same HCPCS code on the second claim line with the JW modifier to explain that 3 mg of the drug was discarded, as this will result in overbilling.
Final Thoughts on the JW Modifier
Overwhelmed with the information presented in this guide? Don’t be. Submitting claims with the JW modifier can become a breeze if you understand the basics. So, let’s quickly recap. First, JW is appended to an HCPCS product code to indicate that some amount of a single-dosage drug or biological was discarded. Second, you must report this modifier on the second claim line with the discarded amount/units. Third and last, you should only use it for FDA-approved drugs and biologicals that are separately payable.
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