RFI #
2786
340B drugs without a CPT but with a modifier (835)
Description
Do you know if a 340B drug can be reported on a claim or other reporting mechanism for the 340B program without a CPT, but ONLY with a modifier? Billing regs seem to say the CPT when a modifier is present. If the CPT has not been defined for the 340B drug, CPT code J3490 or C9399 are to be used.
Scenario
340B drug charges are processing through a DFT message without a CPT code, but with a Modifier in the message.
RFI Response
X12 837 syntax does not allow the reporting of a Procedure Code Modifier without a Procedure Code.
RFI Recommendation
It is recommended to follow the guidelines by the Procedure Code definitions for reporting drugs without a specific procedure code.
DOCUMENT ID
005010X221A1