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Single-Dose Vial Unused Portion Reimbursement Policy for Clinician-Administered Drugs

Last updated on 6/16/2020

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Beginning July 1, 2020, providers may bill and receive reimbursement for the unused portion of weight-based or variable dosing clinician-administered drugs (CADs) manufactured only in single-dose vials. Providers must also include modifier JW on their claims for consideration of reimbursement.

The JW modifier on the claim will identify the unused portion. This applies to both Medicaid and the Children’s Health Insurance Program (CHIP). The policy only applies to medical claims for weight-based or variable dosing CADs, manufactured only in single-dose vials and provided in a professional or outpatient setting.

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