CMS releases FAQs on billing 340B modifiers under hospital OPPS
The Centers for Medicare & Medicaid Services yesterday released , at the request of the AHA, to clarify CMS鈥檚 new modifier policy for billing 340B-acquired drugs under the outpatient prospective payment system. CMS requires that all 340B hospitals use one of two new payment modifiers, beginning Jan. 1, 2018, as part of its final rule that will reduce Medicare Part B payments to certain 340B hospitals. Specifically, 340B hospitals subject to the drug payment reductions are required to use modifier 鈥淛G鈥 for nonpass-through separately payable drugs (i.e., those drugs assigned status indicator 鈥淜鈥) acquired under the 340B program. 340B hospitals that are exempt from the OPPS policy changes, such as rural sole community hospitals, children鈥檚 hospitals and PPS-exempt cancer hospitals, are required to use the informational modifier 鈥淭B鈥 to identify OPPS separately payable drugs purchased with a 340B discount. The FAQs address a wide range of implementation issues, such as identifying drugs that must be billed with modifier 鈥淛G,鈥 how hospital-owned retail pharmacies and non-excepted off-campus provider-based departments are to be treated, and the definition of rural SCHs.