By: Marney Wilson
The UD modifier is used to identify medical claims for outpatient physician-administered drugs and signifies to CMS that they need to pay the manufacturer rebate and the amount to pay the provider. Keep in mind that using the UD modifier is not a recommendation, it is a federal requirement! Potential ramifications of not using the modifier include repaying the difference between the billed amount and the acquisition price, as well as the manufacturer's rebate.
Here are a few tips to ensure your coding is accurate:
When Medicaid is primary payer: Use “UD” modifier for each 340B drug with an acquisition cost. Remember to always verify appropriate modifiers with your state Medicaid program.
When Medicaid is secondary payer: The claim must be appended with the “UD” modifier for each 340B drug if the primary payer did not require the modifier.
When preparing for program audits: Maintain audible records documenting compliance with all 340B Program requirements.
If your organization would benefit from additional guidance or would like a third-party chart audit completed, please reach out! CLC has Certified Chart Auditors on staff who can perform a chart audit that not only checks the compliance box, but also provides valuable feedback and training opportunities for your providers. If you are interested in this service, please reach out to info@communitylinkconsulting.com.