Dear All,
Wow..it’s been quite some time since I wrote to you. I have missed you and I apologize for my quietness. It’s been a crazy busy spring and summer and fall is looking like it’s going to be the same. Am I the only one that feels like time just zooms by?
There are some changes with CMS that I
want to be sure you are aware of. Remember, what CMS does “everyone else follows”.
One big change which is very positive for OMS is that CMS has rolled back the multiple procedure discount for teeth. If you recall, in early 2023 we discovered that a multiple procedure payment indicator of “2” was assigned to the extraction codes. The impact of that is that some carriers
were processing the first extraction at 100% of fee schedule and each additional extraction was discounted by 50%. A huge financial impact to OMFS offices! That has been resolved and CMS has rescinded the indicator and it’s now set back to an indicator of “0” which means 100% of fee schedule for each extraction. Phew…
CMS has recently introduced two new
modifiers for use with HCPCS Level II drug codes.
JW DRUG AMOUNT DISCARDED/NOT ADMINISTERED TO ANY PATIENT
JZ ZERO DRUG AMOUNT DISCARDED/NOT ADMINISTERED TO ANY PATIENT
To submit claims for a waste-required claim, submit two complete claim lines.
Claim line #1:
• HCPCS code for drug given
• No modifier
• Number of units given to
the patient
• Calculated submitted price for ONLY the amount of drug given
Claim line #2:
• HCPCS code for drug wasted
• JW modifier to indicate
waste
• Number of units wasted
• Calculated submitted price for ONLY the amount of drug wasted
To submit claims for a non-discarded
claim, submit one complete claim line.
• HCPCS code for drug given
• JZ modifier to indicate no waste
• Number of units given to the patient
• Calculate submitted price for the amount
given
For further details click below to view this CMS article:
https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleid=55932
For example, if you are administering Botox® as a single dose container with 100 units and you only administer 50 units to the patient and the other 50 units are discarded, it would be reported as follows:
64615 Chemodenervation of muscle(s); muscle(s) innervated by facial, trigeminal, cervical spinal and accessory nerves, bilateral (e.g., for chronic migraine)
J0585 –x 50 Injection, onabotulinum toxin A, 1 unit; 50 units
used
J0585 -JW x 50 50 units discarded
Essentially moving forward, for all single dose vials administered to patients when reporting HCPCS Level II codes, it will be required to report either modifier JZ to report no waste,
or JZ and JW to report the amount administered and wasted.
I promise I will be back in touch soon with more coding updates!
