Use required 340B modifiers for accurate payment

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

  1. Bill on the appropriate claim line(s):
    • a.  Bill on separate claim lines for each separately payable, non-pass through 340B-acquired drug (status indicator K)
    • b. For a claim with multiple drug lines, use the appropriate 340B modifier on each line
  2. JG modifier is required for 340B-eligible providers, who are not exempted, and billing for separately payable Outpatient Perspective Payment System (OPPS) drugs assigned status indicator K

Other 340B updates and reminders

  • Drug payment rate: UnitedHealthcare will continue to pay for 340B-acquired drugs (status indicator K) that include the JG modifier at the discounted rate of average sales price (ASP) minus 22.5%
  • Medicare billing requirements: 340B facilities must follow Centers for Medicare & Medicaid Services (CMS) coding and billing requirements, and provide accurate and complete claim documentation upon request
  • Ongoing payment reviews: UnitedHealthcare will continue to do retrospective reviews on paid 340B claims

Additional resources

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.

*As defined in the Affordable Care Act, section 1927(k)