Modifier JG

20.6.16- Modifier JG (Rev. 11937; Issued: 03-31-23; Effective: 04-01-23; Implementation: 04-03-23) JG: Drug or biological acquired with 340b drug pricing program discount, reported for informational purposes A. General On January 1, 2018, CMS established HCPCS Level II modifier JG to identify and pay 340B-acquired drugs and biologicals. Specifically, beginning January 1, 2018, hospitals paid under the OPPS that are not excepted from the 340B drug payment adjustment, and beginning January 1, 2019, nonexcepted off-campus PBDs of a hospital (that is not otherwise excepted from the 340B drug payment adjustment) paid under the PFS are required to report modifier JG on the same claim line as the drug or biological HCPCS code to identify if a drug or biological was acquired under the 340B Program. The phrase “acquired under the 340B Program” is inclusive of all drugs and biologicals acquired under the 340B Program or PVP, regardless of the level of discount applied to the drug. Effective January 1, 2023, the JG modifier is required to be used by hospitals (except for rural sole community hospitals, children’s hospitals, and PPS-exempt cancer hospitals) to identify 340B drugs for informational purposes only, with no effect on payment. B. Effect on Payment Starting in CY 2018, payment for certain drugs and biologicals (reported with status indicator “K”) acquired through the 340B Program that are furnished by providers paid under the OPPS, and beginning January 1, 2019, payment for certain drugs and biologicals furnished by nonexcepted off-campus PBDs of a hospital paid under the PFS (departments that bill modifier PN on their claim lines), were required to report modifier JG on the same claim line as the drug or biological HCPCS code to identify if a drug or biological was acquired under the 340B Program, which triggered a payment adjustment such that the 340B-acquired drug is paid at the drug’s average sales price minus 22.5 percent (or equivalent payment rate derived from the ASP methodology). Starting September 28th, 2022, CMS revised the OPPS drug files that will apply the default rate (generally ASP plus 6 percent) to 340B-acquired drugs for the rest of that calendar year. Effective January 1, 2023, the presence of modifier JG on a claim to indicate a drug is acquired under the 340B program will not trigger a payment reduction and will be used only for informational purposes. Claims for 340B drugs and biologicals identified with a JG modifier will be paid at the same statutory default rate as non-340B drugs and biologicals. A document explaining the use of this modifier is available via the Internet on the CMS Web site at https://www.cms.gov/files/document/part-b-inflation-rebate-guidance340b- modifierfinal.pdf.