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MA PAP 107

Billing for Drug Waste


Provider Administrative Policy

Section
General Information
Policy Date
January 2012
Status/Date
Revised/June 2012
Provider Type(s)
All Providers  

Disclaimer

Our provider administrative policies contain information regarding claims submission, reimbursement, and other information in order to achieve an efficient relationship with our providers. These policies are not an authorization or explanation of benefits. Blue Cross of Idaho retains the right to add to, delete from and otherwise modify this policy in accordance with our provider contracts.

Policy

Billing for Drug Waste

Blue Cross of Idaho may allow reimbursement for wasted drugs billed over the amount administered to a patient if providers meet the following guidelines.

  • Provider must obtain authorization for smallest single dose vial of the administerd drug. See MAPAP300 and MAPAP301.
  • Provider must bill units that correspond to the smallest single dose vial available, not units actually administered.
  • Provider must bill the drug on one line item. Do not divide the line item in an attempt to show how many units were administered and how many were wasted.
  • Since the billing for the drug is on a single line item, do not append the JW modifier.

Blue Cross of Idaho will only authorize and consider payment for wasted drugs when they are the remains from the smallest single dose vial available. Providers are prohibited from billing for wasted drugs that do not come from a single dose vial. Blue Cross of Idaho will deny any charges submitted for medications not administered from the smallest single does vial as a contractual adjustment for contracting providers.

Examples:

  • A physician administers a drug that comes in a 100 mg vial (smallest dose available), 75 mg of a drug is administered and 25 mg is waste. The provider can bill for the 100 mg represented with a billing unit of 1, which includes the waste.
  • Botox billing unit is 1 unit so any waste from the smallest single dose vial is applicable.

Policy History

Date Action Reason
June 2012 Revised Removed PAP 241 added MAPAP 300

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