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Reminder: 340B-Acquired Drug Claim Appeal Requests

Beginning 1/1/2018, separately payable Part B drugs (assigned status indicator “K”), other than vaccines (assigned status indicator “L” or “M”) and drugs on pass-through payment status (assigned status indicator “G”), that are acquired through the 340B program or through the 340B prime vendor program will be paid at the ASP minus 22.5 percent when billed by a hospital paid under the OPPS that is not excepted from the payment adjustment. Hospitals paid under the OPPS that are not excepted from the 340B drug payment policy are required to report modifier “JG” on the same claim line as the drug HCPCS code to identify a 340B-acquired drug.

Please note than when a service is reimbursed in accordance with Medicare’s national payment policy for 340B-acquired drugs, the amount paid is final. The method of reimbursement is not an appropriate reason for an appeal and an appeal will not be considered when submitted to dispute the CMS 340B national payment policy.

Posted 7/8/2022