340B Modifier Billing Guidance Update

Jul 14, 2023

Below please find billing guidance for using 340B modifiers. 

340B Providers: 

• Billing MaineCare Primary: Providers must use the JG modifier on all drugs purchased under the 340B program. 

• Billing MaineCare Secondary to Medicare:  Providers must use JG or TB modifier on all drugs purchased under the 340B program when MaineCare is secondary to Medicare. 

• Billing MaineCare Secondary to Commercial Insurance: Providers must use JG modifier on all drugs purchased under the 340B program when submitting a claim to MaineCare Secondary. 

• Billing MaineCare for non-340B drugs ***New Requirement:  When submitting claims for drugs that were not purchased under the 340B program use UC modifier. 

340B Hospitals: 

• Billing MaineCare Primary: Hospitals must append JG modifier to all drug claim lines to identify drugs purchased under the 340B program.  

• Billing MaineCare Secondary to Medicare: Hospital Providers must use the JG or TB modifier on all drugs purchased under the 340B program. Medicare requires the JG modifier on most, but not all 340B drugs. Any 340B drugs for which Medicare does not require the use of the JG modifier must be submitted to Medicare with the TB modifier when MaineCare is a secondary payor. Claim lines submitted with the JG or TB modifier will be exempt from MaineCare rebates. 

• Billing MaineCare Secondary to Commercial Insurance: Hospitals must append JG modifier to all drug claim lines to identify drugs purchased under the 340B program.  

• Billing MaineCare for non-340B drugs ***New Requirement:  When submitting claims for drugs that were not purchased under the 340B program use UC modifier. 

Please contact Megan Dinsmore, Provider Relations Specialist, with questions.