Provider Alert! JW Modifier Update

Date: July 7, 2022

Attention: All Providers

HCPCS Codes from TMHP as of May 2022

Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated to the COVID-19 event.  TCHP reserves the right to update and/or change this information without prior notice due to the evolving nature of the COVID-19 event.

Call to action: Texas Children’s Health Plan (TCHP) aligns with Texas Medicaid and Healthcare Partnership (TMHP) regarding the reimbursement policy for the unused portion of a single use vial for clinician-administered drugs. As a reminder, claims submitted for the unused portion and discarded portion of weight-based or variable dosing clinician administered drugs (CADs) manufactured only in single-dose vials, must include the modifier JW for consideration of reimbursement. The JW modifier on the claim identifies the unused portion and discarded portion of the vial contents.

Resources:

Single-Dose Vial Medicaid Drug List is available here from TMHP. PLEASE NOTE THE LIST HAS BEEN UPDATED AS OF May 2022.

How this impacts providers: Providers must enter the dose administered (used portion) line item detail of the CAD and enter the dose discarded (unused portion) line item detail of the CAD on the same claim. The dose discarded (unused portion) line item detail must include the JW modifier to be considered for reimbursement. When billing for reimbursement of wastage on an outpatient claim, the HCPCS and Current Procedural Terminology (CPT) code should always be provided along with the revenue code.

Next steps for providers: Providers should follow the billing guidance outlined above and inform their staff. Providers can refer to the Texas Medicaid Provider Procedure Manual, and the Children with Special Health Care Needs (CSHCN) Services Program Provider Manual.

Resource:

TMHP Manual

If you have any questions, please email Provider Network Management at: providerrelations@texaschildrens.org.

For access to all provider alerts, log into:
www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers.