According to the announcement by Empire BCBS for the state of NY- the payer added a new INFORMATIONAL modifier to represent the unused drug when the provider uses a single vial of medication/biologic. This policy applies to commercial Plan types.
Reimbursement Policy Number: C-11031. https://www.empireblue.com/docs/public/inline/C-18001_NY.pdf
Although the effective date of the policy is 6/17/23 the policy will only apply to the drugs/biologics that are administered to the member for DOS 1/1/24 and thereafter
JW modifier is not permitted when the actual dose of a covered drug/biologic administered from a single dose vial is less than the billing unit, as indicated in the HCPCS code description.
When administering medication/biologic, the provider needs to be conscious of what amount of medication the patient needs for their treatment. For example, if the provider requires 20 units and the medication/biologic drug comes in a 10 or 50 mil vial, then the provider should use the 2 10 mil vials to administer the needed dosage instead of using the 50 mil vial and appending the JW modifier to the unused portion of the medication/biologics.
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