Pharmacy Question for the Week of February 5, 2018

Pharmacy Compliance Question of the Week

Question:

Are there any modifiers to report 340B-acquired drugs to Medicare?

Answer:

The Centers for Medicare & Medicaid Services (CMS) established the following HCPCS Level II modifiers to identify 340B-acquired drugs:

  • Modifier JG—drug or biological acquired with 340B drug pricing program discount
  • Modifier TB—drug or biological acquired with 340B drug pricing program discount, reported for informational purposes.

When applicable, providers are required to report either of these modifiers on outpatient prospective payment system (OPPS) claims (bill type 13X) beginning January 1, 2018. Even though modifier TB is an informational modifier, reporting is mandatory for applicable providers.

Disclaimer: Every reasonable effort was made to ensure the accuracy of this information at the time it was published. However, due to the nature of industry changes over time we cannot guarantee its validity after the year it was published.