Blue Cross and Blue Shield of North Carolina (Blue Cross NC) is implementing policy to align with the Centers for Medicare & Medicaid Services (CMS). Effective August 10, 2021, Blue Cross NC will modify reimbursement for discarded drugs or biologicals for single use and multi-use vials as outlined below. Please refer to the “Drug Wastage” in section 9.66.27 of The Blue BookSM Provider e-Manual for more information related to claim filing.
Blue Cross NC will only reimburse one claim line of an administered drug per day, per provider or same group practice. If multiple lines of the same drug/code are billed on the same claim or date of service and one line does not contain the JW modifier, the line with the lower quantity will be denied.
Single Use Vial or Package
The JW modifier is only valid when used to identify discarded/wasted drug or biological from a single use vial or package. Reimbursement for drug wastage (as indicated by the JW modifier) will never exceed the units contained in the smallest single use vial or package available for purchase from the manufacturer(s). Drug or biologic wastage (JW modifier) must be filed with a separate claim line from the administered drug or biologic in order to be reimbursed. Drug or biologic wastage (JW modifier) alone is not reimbursable.
Multi-use Vial or Package
The JW modifier cannot be used to indicate drug or biological wastage for multi-use vials. Wastage for multi-use vials is not reimbursable.
These changes apply to the following lines of business: Administrative Services Only (ASO), fully insured membership, Blue Card IPP Host and the State Health Plan (SHP).