A Medicare administrative contractor in the southern U.S. has agreed to a recommendation from the Society of Nuclear Medicine and Molecular Imaging (SNMMI) to allow providers to bill for wastage when single-dose vials of radiopharmaceuticals are used.
Palmetto GBA's changes will go into effect immediately in North Carolina, South Carolina, Virginia, and West Virginia, and they will apply to Alabama, Georgia, and Tennessee in 2018 when Palmetto GBA enters those states.
The request to remove the restriction on billing came last month from Denise Merlino, an SNMMI coding consultant. Palmetto announced the change this week.
"After research and discussion with the Centers for Medicare and Medicaid Services, Palmetto GBA will be removing the restrictions of modifier JW use on single-dose vial or single-dose preparation of radiopharmaceuticals," Merlino wrote to SNMMI members.
The JW modifier is a Healthcare Common Procedure Coding System (HCPCS) level II modifier used for a Medicare Part B drug claim to report the amount of drug that is discarded and eligible for payment under the discarded-drug policy.
Palmetto GBA plans to distribute a claims payment issues log (CPIL) with instructions on how providers can have their claims considered with the modifier JW once its claim processing information is updated, Merlino added.
Palmetto GBA provides claims and transaction processing, contact center operations, and technical services to the federal government and other commercial customers.
