Last modified: June 15, 2021
340B claim? Use 340B modifiers to receive accurate Medicare Advantage payments
To maintain claim payment accuracy and integrity, you are required to use modifier JG for covered* outpatient drugs and biologics purchased through the 340B program for your UnitedHealthcare Medicare Advantage patients.
Beginning July 1, 2021, UnitedHealthcare will perform pre-payment claim reviews for covered 340B outpatient drugs to confirm appropriate modifier usage.
What happens if appropriate modifiers aren’t used?
340B program facilities who don’t include the JG modifier on claims for 340B drugs and biologicals will receive a message that the claim may be subject to 340B coding and billing requirements.
The facility can then update the claim or attest that the drug or biological was not purchased through the 340B program, if applicable.
If the claim is not modified and the facility does not complete an attestation, we will assume the drug was purchased through the 340B program and adjust the claim to provide reimbursement at the discounted 340B rate. Standard appeal rights continue to apply.
How to bill 340B claims
Other 340B updates and reminders
See the CMS Medicare Fee-for-Service (FFS) program frequently asked questions for more information on using JG/TB modifiers.
Questions? Contact your Provider Advocate or UnitedHealthcare Provider Services, toll-free, at 877-842-3210, 7 a.m.–5 p.m. CT, Monday–Friday.