Highmark Reimbursement Policy Bulletin
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1 Bulletin Number: RP-003 Drug Wastage and Convenience Kits Effective Date: August 1, 2016 End Date: Issue Date: November 5, 2018 VIEW HISTORY Applicable Commercial Market PA WV DE Applicable Medicare Advantage Market PA WV Applicable Claim Type UB 1500 designation of Professional or Facility application is respective to how the provider is contracted with The Plan. Provider contractual agreement terms in direct conflict with this may supersede this Policy s direction and regional applicability. The purpose of this policy is to provide direction on the Plan s reimbursement for drug wastage (modifier JW) and convenience kits (code J3490). Drug Wastage Highmark does not reimburse discarded contrast material when billed with modifier JW. Providers should bill the appropriate contrast material code and report only the units administered. JW - Drug/Biological Amount Discarded/Not Administered To Any Patient Medicare Advantage Note: Unused drugs or biologicals from single use vials or single use packages that are appropriately discarded and provided under the Competitive Acquisition Program
2 (CAP) for Part B drugs and biologicals, do not require the JW modifier to be reported with that service line. Page 2 of 2 Convenience Kits (Applicable for Commercial Only) Convenience Kits (code J3490) are considered part of the provider s supply allowance used to administer the drug or biological; therefore, convenience kits are not reimbursed by the Plan. These charges are nonbillable and a participating or network provider cannot bill the member for the denied service. REFERENCES: Competitive Acquisition Program (CAP) for Part B drugs and biologicals Drugs/CompetitiveAcquisforBios/index.html Medicare Claims Processing Manual Chapter 17, Drugs and Biologicals, section
3 HISTORY VERSIONS Bulletin Number: RP-003 Drug Wastage and Convenience Kits Effective Date: August 1, 2016 Issue Date: May 21, 2018 Applicable Commercial Market Applicable Medicare Advantage Market Applicable Claim Type End Date: Y R PA PA UB WV WV 1500 DE O T designation of Professional or Facility application is respective to how the provider is contracted with The Plan. Provider contractual agreement terms in direct conflict with this may supersede this Policy s direction and regional applicability. S I H The purpose of this policy is to provide direction on the Plan s reimbursement for drug wastage (modifier JW) and convenience kits (code J3490). Drug Wastage JW - Drug/Biological Amount Discarded/Not Administered To Any Patient Medicare Advantage Note: Unused drugs or biologicals from single use vials or single use packages that are appropriately discarded and provided under the Competitive Acquisition Program (CAP) for Part B drugs and biologicals, do not require the JW modifier to be reported with that service line.
4 Page 2 of 2 Convenience Kits (Applicable for Commercial Only) Convenience Kits (code J3490) are considered part of the provider s supply allowance used to administer the drug or biological; therefore, convenience kits are not reimbursed by the Plan. These charges are nonbillable and a participating or network provider cannot bill the member for the denied service. REFERENCES: Competitive Acquisition Program (CAP) for Part B drugs and biologicals Drugs/CompetitiveAcquisforBios/index.html Medicare Claims Processing Manual Chapter 17, Drugs and Biologicals, section HISTORY
5 Bulletin Number: RP-003 Drug Wastage and Modifier JW Effective Date: August 1, 2016 End Date: Issue Date: December 1, 2017 Applicable Commercial Market PA WV DE Applicable Medicare Advantage Market PA WV Applicable Claim Type UB 1500 designation of Professional or Facility application is respective to how the provider is contracted with The Plan. Provider contractual agreements supersede direction and regional applicability. The purpose of this policy is to provide direction on drug wastage and the use of modifier JW. Medicare Advantage HISTORY Unused drugs or biologicals from single use vials or single use packages that are appropriately discarded and provided under the Competitive Acquisition Program (CAP) for Part B drugs and biologicals, do not require the JW modifier to be reported with that service line. This policy position applies to all commercial and/or Medicare Advantage lines of business as indicated above. Reimbursement policies are intended only to establish general guidelines for reimbursement under Highmark plans. Highmark retains the right to review and update its reimbursement policy guidelines at its sole discretion.
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