NEW MODIFIERS CREATED FOR USE WHEN BILLING 340B DRUGS

Date: 01/14/19

Effective January 1, 2018, the Centers for Medicare & Medicaid (CMS) created two modifiers for use by 340B entities when billing for 340B drugs on CMS-1500 or UB-04 claims.  The new modifiers are as follows:

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

Providers that are enrolled in the 340B program should use either the JG or TB modifier when billing fee-for-service claims to the Indiana Health Coverage Program (IHCP) for 340B drugs for dates of service (DOS) on or after January 1, 2018.  Providers should not use the UD modifier to indicate drugs acquired through the 340B program.  This guidance will not impact claims for the affected DOS that have already been submitted.

Providers should refer to the Billing Instructions for 340B-Acquired Drug section of the January 2018 Update of the Hospital Outpatient Prospective Payment System (OPPS) and the CMS 340B Modifier FAQ on the CMS website at cms.gov for information regarding the proper use of modifiers JG and TB.