June 30, 2007

ACR Radiology Coding Source™ May-June 2007

Medicare to Cover Discarded Drugs and Biologicals

Effective July 1, 2007, Medicare will cover discarded or not-administered drugs and biologicals for single-use vials and packages. Medicare issued Transmittal 1248 (CR 5220), which revises the coverage of discarded drugs and biologicals, in addition to the administered amounts in a single vial or single-use package. Note that the coverage does not include multi-use packages. 

Payment is provided for the amount of the drug or biological administered and amount discarded up to the total amount of the drug indicated on the vial or the package. The policy requires using modifier “JW” with the J HCPCS codes to indicate billing for the unused portion of a single-use drug or biological. 

Physicians are expected to make a good faith effort to minimize the unused portion of the CAP drug and biological when ordering accepting, storing, and using the drugs and biologicals, in order to get reimbursed. CMS recommends providers schedule patients in the way the drugs and biologicals can be used efficiently.