Apple Health Medicare Crossover Claims Only – Use Modifier JW for Splitting Single-Dose Vials


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Apple Health (Medicaid): Provider Alert

Dear Pharmacy Provider,

Effective immediately, for Medicare crossover claims only, when billing for splitting single-dose vials, use modifier JW. If modifier JW is used on any claim type other than a Medicare crossover claim, the agency will not pay the claim.

The agency has an approval process for splitting single-dose vials. For more information, including how to obtain agency approval to bill for splitting single dose vials, see the Prescription Drug Program Billing Guide.