340B Modifier 
Selection

Specify the 340B Modifier for your organization.

Customers must select one of three options:

  1. JG (Hospital-Based) = Hospital-based, except for rural sole community hospitals, children’s hospitals, and PPS-exempt cancer hospitals.
  2. TB (Non-hospital Based) = Non-hospital based, limited to rural sole community hospitals, children’s hospitals, and PPS-exempt cancer hospitals.
  3. Opt-out = This is an option for customers who carve out Medicare Part B plans.
Customers must submit this form by October 31, 2023.