PPS 340B hospitals must resubmit 2022 claims for drug payment correction

December 13, 2022

Earlier this year, the US Supreme Court overturned cuts made by the Centers for Medicare and Medicaid Services to PPS hospitals for hospital administered drugs under the 340B program. For dates after September 28, 2022, the Medicare Administrative Contractors (MAC) will automatically adjust payments to reflect the restored payment level. Hospitals will need to resubmit 340B drug claims incurred between January 1 and September 28, 2022 as provider-submitted corrections. Claims previously paid at the reduced rate based on the “JG” modifier should be submitted using type of bill (TOB) XX7 with condition code D9 and remarks indicating “340B Adjustment.” A copy of the MAC instructions is on the Noridian website. This does not apply to cuts that occurred between January 2018 and December 2021. A proposal for a remedy for reductions occurring prior to January 1, 2022 will be released by HHS sometime before next year’s CY 2024 OPPS payment rule. (Andrew Busz, andrewb@wsha.org)


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