On September 28, 2022, the United States District Court for the District of Columbia vacated the differential payment rates for 340B-acquired drugs in the Calendar Year 2022 Outpatient Prospective Payment System (OPPS) final rule with respect to their prospective application. The Court ruled:

  • The U.S. Centers for Medicare & Medicaid Services (CMS) can’t apply the average sales price (ASP) minus 22.5% drug payment rate for these drugs for the rest of the year
  • As a result, CMS will revert to paying the default rate (generally ASP plus 6%) under the Medicare statute for 340B-acquired drugs

CMS is uploading revised OPPS drug files that will apply the default rate (generally ASP plus 6%) to 340B-acquired drugs for the rest of the year. CMS also will reprocess claims our contractors paid on or after September 28, 2022, using the default rate (generally ASP plus 6%).

Source: U.S. Centers for Medicare & Medicaid Services (CMS)

About 3Gen
3Gen Consulting has always been in the forefront when it comes to adding value. We always believe in setting our own standards. What sets us apart is the investment that we make in our people, processes and innovation to provide you with market leading healthcare revenue cycle management services. We work as an extension of our clients’ teams by focusing on their key challenges, aligning with their culture and delivering the best results.

If you’re interested in finding the right medical billing and coding services partner, contact us today.

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