CHA News Article

CMS Issues Guidance on 340B Drug Pricing Program Billing Modifiers
CHA continues to oppose program cuts

The Centers for Medicare & Medicaid Services (CMS) has issued the attached frequently asked questions on the billing modifiers required under its new 340B Drug Pricing Program payment policy, as finalized in the calendar year 2018 outpatient prospective payment system (OPPS) final rule. Absent congressional or judicial action, the modifiers are mandatory beginning Jan. 1.

In the OPPS final rule, CMS established two Healthcare Common Procedure Coding System (HCPCS) Level II modifiers to identify 340B-acquired drugs: “JG” for drugs or biologicals acquired under the 340B program and subject to the new payment policy, and “TB” for drugs or biologicals acquired through the 340B program but not subject to the new payment policy (for informational purposes only). The payment adjustment applies to drugs billed with the JG modifier with status indicator “K.”

While the TB modifier is for informational purposes, all hospitals except critical access hospitals are required to bill with the modifier for pass-through drugs (status indicator G). Notably, CMS is requiring non-excepted off-campus provider based departments to bill the modifier TB for both pass-through and separately payable drugs acquired under the 340B program.

CHA remains concerned that billing these modifiers will be administratively burdensome and is continuing advocacy to avert cuts to the 340B program, including supporting legislation that would prevent these cuts from taking effect. In addition, CHA has joined 31 other state hospital associations in filing an amicus brief in support of the American Hospital Association’s lawsuit to prevent the policy from going into effect.