Production Alert Details

340B-Acquired Drugs Payment Differential Cancellation

Date Reported:
Date Updated:
Date Resolved:
Provider Types Impacted:

Part A providers in Jurisdiction K and Jurisdiction 6

Reason Code(s):
Claim Coding Impact:

Description of Issue

Previously applied differential payment rates for 340B-acquired drugs are no longer valid as of 9/28/2022, as per a ruling by the United States District Court for the District of Columbia. As a result, the CMS will revert to paying the default rate (generally ASP plus 6%) under Medicare statute for 340B-acquired drugs. CMS is uploading revised OPPS drug files that will apply the default rate (generally ASP plus 6%) to 340B-acquired drugs for the rest of the year. CMS also will reprocess claims our contractors paid on or after 9/28/2022 , using the default rate (generally ASP plus 6%).

National Government Services Action

As per CMS instructions, once the revised 2022 OPPS drug files (all four quarters in 2022) are loaded into production regions, National Government Services shall reprocess/adjust 2022 date of service claims with the JG modifier that were paid on or after 9/28/2022 until the revised drug files for all four quarters of 2022 are loaded.

Provider Action

Although Part A MACs shall not reprocess 2022 date of service claims paid prior to 9/28/2022 as contractor-initiated adjustments, Part A MACs shall process provider-submitted adjustments to 2022 date of service claims that were paid prior to 9/28/2022.

Proposed Resolution/Fix