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  • Medicare-FFS Program Billing 340B Modifiers under the Hospital . . .
    For a claim with multiple drug lines, the appropriate 340B modifier is required on each line of a 340B-acquired drug A 340B modifier is not required on claim lines of a non 340B-acquired drug (regardless of status indicator), a product assigned status indicator “L” (Not paid under OPPS Paid under reasonable cost; not subject to deductible or
  • Modifier JG - JD DME - Noridian
    Drug or biological acquired with 340B drug pricing program discount, reported for informational purposes The JG modifier was established by CMS and is required for 340B participating entities for separately payable Part B drugs or biologicals acquired under the 340B Drug Pricing Program Required for dates of service on after January 1, 2024
  • CMS Updates 340B Modifier Guidance - AAPC Knowledge Center
    All other 340B covered entities should either report modifier JG for separately payable drugs acquired through the program in CY 2024 or transition to modifier TB While these modifiers are already required for a variety of hospitals paid under the Outpatient Prospective Payment System ( OPPS ), all 340B covered entities must use these
  • Reimbursement - Medi-Cal
    Drugs Purchased Under the 340B Pricing Program Providers billing drugs purchased pursuant to the 340B program (covered entities and contract pharmacies) are required to bill an amount not to exceed the entity’s actual acquisition cost for the drug, as charged by the manufacturer at a price consistent with
  • CMS Requiring All 340B Entities to Use Claims Modifiers When Billing . . .
    Disproportionate share hospitals, rural referral centers, and non-rural sole community hospitals have been using the “JG” modifier since 2018 under CMS’s now-defunct deep cut in Part B reimbursement for the hospitals’ 340B-acquired drugs
  • 340B Compliance with New Billing Modifier Requirements - CPS
    Providers and suppliers, such as contract pharmacies, should submit the “JG” modifier when billing Medicare Part B for status indicator “K” 340B drugs Starting January 1, 2025, all 340B covered entities must transition to the “TB” modifier on 340B claims for separately payable Medicare Part B drugs and biologics Covered entities
  • 340B Drug Pricing Program billing change — modifier JG
    Beginning January 1, 2025, the Centers for Medicare and Medicaid Services will no longer permit use of the JG modifier for claims with a service date of January 1, 2025, or later related to drugs acquired through the 340B Drug Pricing Program Claims with a service date January 1, 2025, or later must use the TB modifier instead
  • Revised Part B Inflation Rebate Guidance: Use of the 340B Modifier
    SUBJECT: Revised Part B Inflation Rebate Guidance: Use of the 340B Modifier This guidance is a revision to the 340B Modifier Guidance, titled Part B Inflation Rebate Guidance: Use of the 340B Modifiers, initially published on December 20, 2022 This guidance revises the modifiers that should be used to report drugs acquired under the 340B
  • Medicare Part B Inflation Rebate Guidance: Use of the 340B Modifier
    This product educates on how to report modifiers “JG” or “TB” on claim lines for drugs acquired through the 340B Program effective January 1, 2024 The Inflation Reduction Act of 2022 establishes a Part B inflation rebate by manufacturers for certain single source drugs and biologicals with prices increasing faster than the rate of
  • All Facilities Required to report 340B Modifiers in 2024
    The modifier requirement does not apply to all drugs purchased under 340 (B), although hospitals may opt to report the modifier for all 340B drugs The obligation to append a modifier applies to only Part B drugs and biologicals assigned OPPS Status Indicator G or K (“separately payable” under OPPS )
  • What are HCPCS Modifiers TB and JG? A Guide to 340B Drug Pricing . . .
    By including Modifier JG, the claim would indicate that the beta-blocker drug was acquired under the 340B Drug Pricing Program but does not explicitly identify the provider as a “select entity ” This use case showcases the nuances of HCPCS Modifier usage, highlighting the distinction between Modifier TB and Modifier JG Proper utilization
  • 340B Drug Program - JF Part A - Noridian - Noridian Medicare
    CMS Billing 340B Modifiers under the Hospital OPPS FAQs; CMS MLN Fact Sheet Medicare Part B Inflation Rebate Guidance: Use of the 340B Modifier; 340B Drug Pricing Program Omnibus Guidance, 80 FR 52300 (August 28, 2015) 340B Drug Pricing Program, Title 42, Volume 1, Part 10; Health Resources Services Administration, OPA





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