UPDATED: Latest JW-Modifier list for medical drugs (CADs)

Date: January 24, 2023

Attention: All Providers

Effective date: January 1, 2023

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: The JW modifier is a Healthcare Common Procedure Coding System (HCPCS) modifier required to be reported on a claim to account for the amount of a drug that is discarded and eligible for payment. The modifier should only be used for claims that bill single-dose container drugs.

How this impacts providers: Provider reporting guidance:

• Providers are required to report the JW modifier on all claims that bill for drugs and biological drugs separately payable under Medicaid. This includes unused and discarded amounts from single-dose containers or single- use packages/single-dose containers.
• Providers must also document the amount of discarded drugs in the members’ medical records. Payers will use the JW modifiers to calculate discarded drug refunds.
  
  

Action providers must take: Providers and their billing offices/personnel should be aware of the most recent changes to the approved list of HCPCS codes eligible for JW-modifier billing. Failure to adhere to the list may result in potential waste/abuse investigations.

Summary of changes:

All coding information:

If you have any questions, please email TCHP Pharmacy at:  TCHPPharmacy@texaschildrens.org.

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