Appropriate Medicare Drug Billing

Ensure that units of drugs or biologicals administered to patients are accurately reported in dosage/units specified in the Healthcare Common Procedure Coding System (HCPCS) code descriptor. Before submitting, review the complete long descriptors for the appropriate HCPCS code. The short descriptors are limited to 28 characters so they do not always capture the complete description of the drug.

When submitting a claim, units should be reported in multiples of the dosage included in the long HCPCS descriptor. If the dosage given is not a multiple of the number provided in the HCPCS code description, the provider shall round up to the nearest whole number in order to express the number as a multiple.

When billing for a single-use vial and part of the drug is being discarded, bill the discarded amount with the JW modifier on a separate line. Multi-use vials are not subject to payment for any discarded amounts of the drug. Incorrect billing may result in the denial of the claim.

Examples:

References:

Medicare Learning Network (MLN) Special Edition Article SE1316-Incorrect Number of Units Billed for Rituximab (HCPCS J9310) and Bevacizumab (HCPCS C9257 and J9035) – Dose versus Units Billed

MLN Matters Article MM9603-JW Modifier: Drug Amount Discarded/Not Administered to any Patient