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PAP 270

Billing for Drug Waste


Provider Administrative Policy

Section
General Billing
Policy Date
January 2012
Status/Date
Revised/ August 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 the following criteria are met:

  • Provider must obtain authorization for smallest single dose vial of the administered drug. See PAP 241.
  • 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 the smallest single dose vial as a contractual adjustment for contracting providers.

Scenario:

  • A physician administers a drug that comes in a 100 mg vial, which is the smallest dose available. The physician administers 75 mg of a drug, leaving 25 mg wasted. The provider's claim to Blue Cross of Idaho should reflect a line item for the drug with units representative of the full 100 mg, which includes the waste.

Policy History

Date Action Reason
August 2012 Revised Changed the two examples to one scenario

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