Don’t Let Drug Waste Shrink Your Bottom Line

Because botulinum toxin has a short shelf life (as little as four hours), physicians must often discard an unused portion of the drug. The cost of the drug means that providers cannot afford to throw away supplies without reimbursement.
Medicare will reimburse for unused Botox/Myobloc drug supplies, but your documentation must reflect the exact drug amount the physician discarded. Specifically, if a provider bills for an unused portion of botulinum toxin, "both the amount of the agent administered and the amount discarded must be documented in the patient’s medical record," according to CMS guidelines
Important: You can bill for Botox supplies only if your facility purchases and provides the drug. In some cases, for instance, the insurer will preauthorize the injection and supply the drug from its own pharmacy.
Schedule for Maximum Efficiency

To prevent waste and to lower costs, Medicare and other insurers encourage physicians to schedule several patients to receive injections within the same one- to four-hour period.
For each patient receiving botulinum toxin, the physician should document in block 24G of the CMS-1500 claim the exact number of units she provides. For the last patient to receive injections from a vial, you should also record the amount (in units) of wasted medication. Add the units injected to the number wasted, and report the total on the final claim. Ensure that the provider recorded these amounts in the chart, as well.
For instance: A neurologist opens a single 100-unit vial of Botox. She injects three patients with 30 units each. For the first two patients, you would list J0585 x 30 on line 24G of the claim form. For the final patient, you should list 30 units provided and 10 units wasted, for a total of 40 units.
Be aware of your payer’s guidelines: Some carriers have specific guidelines for reporting wastage. For instance, many Medicare payers require that providers append modifier JW (Drug amount discarded/not administered to any patient) to the supply code when reporting wasted drugs.
In the above example, if the third patient was covered by TrailBlazer Medicare, you would submit the claims as J0585, with 30 units on the first line and J0585-JW x 10 units on the second line.

- Published on 2008-04-09