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.

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