April 6, 2023
In July 2023, new drug edits will be implemented in the Premera claim editor. To support those edits, the following payment policies will be updated:
The coding guidelines on how to correctly submit NDC drug codes will be enforced with claim dates of service on and after July 8, 2023, for all drug Healthcare Common Procedure Coding System (HCPCS) codes submitted on a professional or facility claim. In addition, these two policies have been expanded with guidelines on how to correctly code for drugs that are wasted, discarded or not administered from a single use vial or package by appending Modifier JW - Drug amount discarded/not administered to any patient.
The coding guidelines in this policy are still applicable to professional claims and will also be enforced with claim dates of service on and after July 8, 2023.
Review the details in these policies to learn how to correctly code for drug wastage and how to correctly code valid/active NDC drug codes on professional and facility claims.