Updated Guidance for 340B Modifiers from CMS in 2024 and 2025

340B modifier

The Centers for Medicare and Medicaid Services (CMS) recently updated guidance on the use of 340B modifiers by Medicare providers and reimbursement providers for drugs Part B biologics and the 340B Drug Enforcement Program. Published participation. The purpose of this rulemaking is to inform all provider types about the newly amended 340B requirements for 2024 and 2025.

Inflation Reduction Act:

The Inflation Reduction Act of 2022 requires the cost of certain biological and biologic products to exceed the rate of inflation.

Modifiers JG and TB refer to drug components obtained through the 340B drug pricing program to effectively implement the Part B cost reduction program; because 340B components are excluded from the Part B cost reduction program.

JG Drugs or biologicals purchased with 340B modifiers to reduce. Drug costs published in the news.   Tuberculosis Drugs or biological products purchased under 340b modifiers to reduce drug costs have been published for informational purposes for selected companies.

 Effective January 2024:

Effective January 1, 2024, CMS is requiring all covered 340B entities to report changes in JG or TB on the claim line for drugs obtained through program costs, both hospital and non-hospital. In 2024, covered 340B entities may continue to use these changes or transmit TB.

For claims beginning January 1, 2024, the following types of providers must continue to use the discount modifier for purchased 340B drugs on separate payment lines:

    • Hospital admissions
    • Maryland paid all or all hospital charges
    • Independent Departmental Service Centers
    • Rural Community Hospitals
    • Children’s Hospitals
    • PPS Exempt Cancer Hospitals

All other 340 B-covered facilities must report JG changes for miscellaneous reimbursement drugs obtained through the program or for the transition to tuberculosis conversion in 2024. While 340B modifiers are required for OPPS, all affected 340B entities must begin using these modifiers beginning January 1, 2024.

As of January 2025:

As of January 1, 2025, all 340 B-covered entities must use the modified TB claim, even if they used the JG modifier in 2024. This includes covered entities that do not currently report the change, such as the Ryan White Clinic and hemophilia clinics, which are required to report the modifier JG for 340B drugs purchased in 2024 on a separate Part B payment line. Distributors and suppliers affiliated with 340B covered entities are also required to submit the appropriate change for the drug to the payment line.

To ensure the necessary changes to the billing system, CMS encourages covered 340B entities and recommends that third-party suppliers and providers begin using the TB modifier as soon as possible rather than waiting until 2025.

Conquer Medical Billing Errors: Your Guide to Fixing Incorrect Codes

Identify the Error:

Pinpoint the specific error you believe exists in the coding. This might involve reviewing an Explanation of Benefits (EOB) or contacting your insurance provider for clarification.

Procedure codes: Ensure they accurately reflect the services rendered.

Place of service codes: Verify they match the location where the service was provided (e.g., hospital outpatient, physician’s office).

Diagnosis codes: Confirm they correspond to your medical conditions.

Collect Documentation: Get a copy of the medical record associated with the service in question. This will help substantiate your claim of a coding error.

Contact the Medical Coding Company:

Initiate Communication: Reach out to the medical coding company handling your bill. You can usually do this by phone, email, or an online patient portal.

Explain the Error:

Clearly explain the error you identified and why you believe it’s incorrect. Mention any documentation you have that supports your claim.

Allzones: Be prepared to provide the following information when contacting the coding company:

    • Your name and patient ID number
    • The date of service in question
    • A clear description of the suspected coding error
    • Copies of relevant medical records (if available)

Request a Re-review: Ask for the medical coding company to re-review the claim based on the information you provided.