This article is for providers who bill for drugs and biologicals
As a reminder, our existing Drug Wastage payment policy applies to contracted providers who bill for covered, medically necessary drugs or biologicals.
As a reminder, our existing Drug Wastage payment policy applies to contracted providers who bill for covered, medically necessary drugs or biologicals. To access this fee schedule, login and go to Office Resources > Policies & Guidelines > Payment Policies.
Below are important billing guidelines outlined within our Drug Wastage payment policy. Please adhere to our payment policy to avoid a claim denial or post-payment recovery.
- Bill modifier JW for the drug amount discarded or not administered to any patient. The units billed must reflect the amount of discarded drug or biological and should be billed on a separate line from the amount of drug or biological administered, including Not Otherwise Classified (NOC) and unlisted codes.
- Units billed must be the appropriate size vial, or combination of vials, to deliver the appropriate administered dose.
- Submit the appropriate 11-digit National Drug Code (NDC) number used for any prescribed drug or biological administered for the date of service billed (including NOC and unlisted codes).
- Do not include hyphens when entering the NDC number.
- Also include any applicable revenue, HCPCS, and CPT codes.
- Document the reason for wastage in the patient’s medical record.
- Do not bill Blue Cross for:
- Drugs or biologicals that were not administered to the patient.
- Drug wastage associated with multi-use vial drugs or biologicals.
Please refer to our Drug Wastage payment policy for additional reimbursement and billing requirements.
Related payment policies
Questions?
If you have any questions, please call Network Management and Credentialing Services at
1-800-316-BLUE (2583). As always, thank you for the care you provide to our members.
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