340B Modifier Billing Guidance Update

Dec 23, 2024

The Centers for Medicare & Medicaid Services (CMS) issued updated guidance on the use of 340B modifiers for providers and suppliers participating in the 340B Drug Pricing Program and who bill separately for payable Part B drugs and biologicals.  

Effective January 1, 2025, providers must use the TB modifier on all 340B drugs provided to MaineCare members whether billing MaineCare for primary or secondary claims.  

If the drug submitted was not purchased under the 340B program, you must use the UC modifier. The UC modifier is used when auditing claims to indicate that the drug can be used for rebate purposes.

MaineCare cannot collect rebates on drugs purchased using the 340B program. The modifier TB prevents MaineCare from collecting a rebate, while the UC modifier indicates that a rebate can be collected from the manufacturer. 

Claims are routinely audited for inclusion of all necessary information such as HCPCS codes and NDC numbers by the Office of Inspector General, MaineCare, and manufacturers.  

Please contact Shannon Beggs, Provider Relations Specialist, with questions.