We have some good news on the 340b payment reductions for calendar year 2022 and forward!
The US District Court for the District of Columbia has ruled that the 2022 reduced 340b payment rates of ASP minus 22.5% should be vacated and requires CMS to implement the higher payment rates of ASP plus 6% immediately.
For now, this decision only applies to calendar year 2022 and forward; but, we will continue to monitor any developments that may impact prior year payments.
The MAC will begin processing claims paid on or after 9/28/2022. We recommend that you check those processed claims for the correct payment of ASP+6%.
In order to receive higher payments for 340b claims paid between 1/1/2022 and 9/27/2022, you should submit adjustment claims as soon as possible.
Modifier code of “JG” should be used with the bill type of (TOB) XX7 and condition code of D9, indicating 340b adjustment.
Timely billing rules will apply, so it is important to resubmit claims as soon as possible.
If you would like to discuss this further or have additional questions, please contact:
- Traudi Bandura at 469-361-0125, traudib@dhcg.com
- Mandy Cox at 469-361-0126, mandyc@dhcg.com
