CMS
CMS is requiring all 340B covered entities by Jan. 1, 2024, to use claims modifiers to identify drugs as having been purchased through 340B when they bill for separately payable Medicare Part B drugs.

CMS Requiring All 340B Entities to Use Claims Modifiers When Billing Part B for 340B Drugs

The U.S. Centers for Medicare & Medicaid Services starting Jan. 1, 2024, will require all 340B covered entities—hospital and grantee—to use claims modifiers to identify drugs as having been purchased through 340B when they bill for separately payable Medicare Part B drugs. In the meantime, it is encouraging entities to start using the modifiers “as soon as possible.”

A CMS guidance document on the agency’s website dated Dec. 20 describes the new mandate. CMS said it issued the requirement to implement new Part B rebates manufacturers will owe Medicare when their drug prices increase faster that the rate of inflation. Manufacturers do not have to pay inflation rebates drugs sold at a 340B discount but will continue to be subject to an inflation penalty on non-Medicare drugs.

The U.S. Centers for Medicare & Medicaid Services starting Jan. 1, 2024, will require all 340B covered entities—hospital and grantee—to use claims modifiers to identify drugs as having been purchased through 340B when they bill for separately payable Medicare Part B drugs. In the meantime, it is encouraging entities to start using the modifiers “as soon as possible.”

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