Which drugs fall under the JW modifier policy?
Generally, the modifier policy applies to all separately payable Part B drugs that are designated as single-use or single dose on the FDA-approved label or package insert. Accordingly, the use of the modifier is not appropriate for drugs that are from multiple-dose vials or packages. However, the JW modifier is not required for drugs that are not separately payable, such as packaged OPPS drugs or drugs administered in the FQHC or RHC setting, and drugs paid under the Part B drug Competitive Acquisition Program (CAP). The CAP remains on hold and there is no current list of CAP medications.
This question was answered in our annual CT/MR Coding: Best Practices and Avoiding Common Mistakes webcast. For more hot topics relating to radiology services, please visit our store or call us at 1.800.252.1578, ext. 2.