{"id":6833,"date":"2026-07-28T14:47:08","date_gmt":"2026-07-28T14:47:08","guid":{"rendered":"https:\/\/medibillmd.com\/blog\/?p=6833"},"modified":"2026-07-28T14:47:09","modified_gmt":"2026-07-28T14:47:09","slug":"tb-modifier","status":"publish","type":"post","link":"https:\/\/medibillmd.com\/blog\/tb-modifier\/","title":{"rendered":"What is a TB Modifier in Medical Billing?"},"content":{"rendered":"\n<p class=\"wp-block-paragraph\">Did you know that 340B discounted purchases had reached <a href=\"https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC12188212\/\" target=\"_blank\" rel=\"noreferrer noopener nofollow\">$66 billion<\/a> during the period 2018 to 2023? Besides, the 340B program grew at a rate 3 times that of non-340B sales based on list prices during the same period.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">But what exactly is the <a href=\"https:\/\/www.340bhealth.org\/members\/340b-program\/overview\/\" target=\"_blank\" rel=\"noreferrer noopener nofollow\">340B program<\/a>? It was designed by Congress in 1992 to help designated providers offer affordable care for vulnerable populations.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">If you are a 340B participating entity, then you must know about the TB modifier. This guide will cover everything from clinical scenarios to guidelines. So, continue reading!<\/p>\n\n\n\t\t\t\t<div class=\"wp-block-uagb-table-of-contents uagb-toc__align-left uagb-toc__columns-1 uagb-toc__collapse uagb-block-01c12590      \"\n\t\t\t\t\tdata-scroll= \"1\"\n\t\t\t\t\tdata-offset= \"30\"\n\t\t\t\t\tstyle=\"\"\n\t\t\t\t>\n\t\t\t\t<div class=\"uagb-toc__wrap\">\n\t\t\t\t\t\t<div class=\"uagb-toc__title\">\n\t\t\t\t\t\t\tTable Of Contents\t\t\t\t\t\t\t\t\t\t\t\t\t<svg xmlns=\"https:\/\/www.w3.org\/2000\/svg\" viewBox= \"0 0 384 512\"><path d=\"M192 384c-8.188 0-16.38-3.125-22.62-9.375l-160-160c-12.5-12.5-12.5-32.75 0-45.25s32.75-12.5 45.25 0L192 306.8l137.4-137.4c12.5-12.5 32.75-12.5 45.25 0s12.5 32.75 0 45.25l-160 160C208.4 380.9 200.2 384 192 384z\"><\/path><\/svg>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"uagb-toc__list-wrap \">\n\t\t\t\t\t\t<ol class=\"uagb-toc__list\"><li class=\"uagb-toc__list\"><a href=\"#tb-modifier-description\" class=\"uagb-toc-link__trigger\">TB Modifier \u2013 Description<\/a><li class=\"uagb-toc__list\"><a href=\"#scenarios-where-the-tb-modifier-is-applicable\" class=\"uagb-toc-link__trigger\">Scenarios Where the TB Modifier is Applicable<\/a><ul class=\"uagb-toc__list\"><li class=\"uagb-toc__list\"><a href=\"#severe-asthma-management-at-a-ryan-white-clinic\" class=\"uagb-toc-link__trigger\">Severe Asthma Management at a Ryan White Clinic<\/a><li class=\"uagb-toc__list\"><li class=\"uagb-toc__list\"><a href=\"#hemophilia-factor-infusion-via-an-affiliated-contract-pharmacy\" class=\"uagb-toc-link__trigger\">Hemophilia Factor Infusion via an Affiliated Contract Pharmacy<\/a><li class=\"uagb-toc__list\"><li class=\"uagb-toc__list\"><a href=\"#oncology-treatment-at-a-dsh\" class=\"uagb-toc-link__trigger\">Oncology Treatment at a DSH<\/a><\/li><\/ul><\/li><li class=\"uagb-toc__list\"><a href=\"#tb-modifier-billing-guidelines\" class=\"uagb-toc-link__trigger\">TB Modifier \u2013 Billing Guidelines<\/a><ul class=\"uagb-toc__list\"><li class=\"uagb-toc__list\"><a href=\"#mandatory-universal-transition\" class=\"uagb-toc-link__trigger\">Mandatory Universal Transition<\/a><li class=\"uagb-toc__list\"><li class=\"uagb-toc__list\"><a href=\"#broad-supplier-provider-applicability\" class=\"uagb-toc-link__trigger\">Broad Supplier &amp; Provider Applicability<\/a><li class=\"uagb-toc__list\"><li class=\"uagb-toc__list\"><a href=\"#claim-line-application-rules\" class=\"uagb-toc-link__trigger\">Claim Line Application Rules<\/a><\/li><\/ul><\/li><\/ul><\/li><li class=\"uagb-toc__list\"><a href=\"#conclusion\" class=\"uagb-toc-link__trigger\">Conclusion<\/a><\/ul><\/ul><\/ol>\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\n\n\n<div style=\"height:30px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<h2 class=\"wp-block-heading\"><strong>TB Modifier<\/strong><strong> \u2013 Description<\/strong><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">The TB modifier indicates that the reported drug or biological was acquired with a 340B drug pricing program discount.&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The Centers for Medicare and Medicaid (CMS) introduced it under the <a href=\"https:\/\/www.cms.gov\/files\/document\/mln4800856-medicare-part-b-inflation-rebate-guidance-use-340b-modifier.pdf\" target=\"_blank\" rel=\"noreferrer noopener nofollow\">Medicare Part B Inflation Rebate Guidance<\/a>. All 340B participating entities must report modifier TB for separately payable Part B drugs or biologicals acquired under the 340B drug pricing program.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Besides, it is only an informational modifier. That is, it does not trigger a payment adjustment or a reduction in reimbursement rates. Instead, it is utilized solely for manufacturer rebate tracking and accounting. Also, it prevents duplicate dual-discount penalties on inflation rebate calculations.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><strong>Scenarios Where the <\/strong><strong>TB Modifier<\/strong><strong> is Applicable<\/strong><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Let\u2019s review a few real-world clinical scenarios where the TB modifier applies:<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>Severe Asthma Management at a Ryan White Clinic<\/strong><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Picture a Medicare beneficiary with severe eosinophilic asthma. He receives a specialized, separately payable biologic injection, such as Mepolizumab, at a 340B-covered, non-hospital-based Ryan White HIV\/AIDS clinic.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Since the drug was acquired through the 340B program and the claim is subject to Medicare\u2019s 340B reporting rules, the billing team must append the TB modifier to the Part B drug claim line with the appropriate medication HCPCS code.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>Hemophilia Factor Infusion via an Affiliated Contract Pharmacy<\/strong><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Consider a patient with severe hemophilia A who requires an infusion of a separately payable clotting factor product. However, the medication is dispensed and managed through a specialized contract pharmacy or supplier, i.e., affiliated with a 340B-covered Hemophilia Treatment Center.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Thus, the affiliated supplier or pharmacy can append the TB modifier to the specific drug claim line when billing Medicare Part B for the 340B-acquired factor product. It is essential to maintain proper compliance with the Inflation Reduction Act&#8217;s inflation rebate tracking.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>Oncology Treatment at a DSH<\/strong><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Imagine a patient with stage IV colon cancer. He receives an intravenous infusion of a separately payable chemotherapy drug at an outpatient hospital clinic.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Note that the hospital is a registered 340B disproportionate share hospital (DSH). Besides, it purchased the biological drug at a 340B discount.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Here, the hospital billing team must submit the TB modifier to the claim line for the appropriate chemotherapy drug code.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><strong>TB Modifier<\/strong><strong> \u2013 Billing Guidelines<\/strong><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Discussed below are some of the essential billing guidelines for the TB modifier:<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>Mandatory Universal Transition<\/strong><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Under the Medicare Part B Inflation Rebate Guidance, all 340B-covered entities must use TB on claim lines for separately payable Part B drugs. These include both hospital-based and non-hospital-based providers.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The JG modifier is no longer permitted for Part B claims, and any entity that previously used it must transition to the TB modifier, effective January 1, 2025.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>Broad Supplier &amp; Provider Applicability<\/strong><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Note that any supplier and healthcare provider who wants to bill Medicare Part B for a discounted 340B drug must use the TB modifier. These include:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Grantees and non-hospital entities such as Ryan White HIV\/AIDS clinics, hemophilia clinics, and Federally Qualified Health Centers (FQHCs).<\/li>\n\n\n\n<li>Outpatient Prospective Payment System (OPPS) hospitals.<\/li>\n\n\n\n<li>Previously exempt or optional, critical access hospitals (CAHs) must report modifier TB.<\/li>\n\n\n\n<li>Third-party providers or suppliers, including contract pharmacies billing on behalf of or affiliated with a 340B-covered entity.<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>Claim Line Application Rules<\/strong><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">The TB modifier must be appended directly to the individual claim line for separately payable Medicare Part B drugs and biologicals. This primarily applies to those assigned a CMS status indicator of &#8216;K&#8217;.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Additionally, you should utilize automated billing configurations and claim scrubbing tools to flag missing modifiers. This will enable you to actively correct and resubmit claims to maintain regulatory compliance.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><strong>Conclusion<\/strong><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">To summarize, the TB modifier acts as an informational tag only. Besides, it highlights to Medicare Part B that the reported drug or biological was acquired with a 340B drug pricing program discount.&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Hopefully, this guide will help you use it properly. However, if you have trouble streamlining your billing workflow, feel free to opt for <a href=\"https:\/\/medibillmd.com\/services\/medical-billing-services\" target=\"_blank\" rel=\"noreferrer noopener\"><strong>medical billing services<\/strong><\/a> from professionals like MediBillMD.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Did you know that 340B discounted purchases had reached $66 billion during the period 2018 to 2023? Besides, the 340B [&hellip;]<\/p>\n","protected":false},"author":7,"featured_media":6834,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_eb_attr":"","content-type":"","_uag_custom_page_level_css":"","site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"default","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","ast-disable-related-posts":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"footnotes":""},"categories":[1],"tags":[],"class_list":["post-6833","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-uncategorized"],"uagb_featured_image_src":{"full":["https:\/\/medibillmd.com\/blog\/wp-content\/uploads\/2026\/07\/What-is-TB-Modifier-in-Medical-Billing.webp",1200,720,false],"thumbnail":["https:\/\/medibillmd.com\/blog\/wp-content\/uploads\/2026\/07\/What-is-TB-Modifier-in-Medical-Billing-150x150.webp",150,150,true],"medium":["https:\/\/medibillmd.com\/blog\/wp-content\/uploads\/2026\/07\/What-is-TB-Modifier-in-Medical-Billing-300x180.webp",300,180,true],"medium_large":["https:\/\/medibillmd.com\/blog\/wp-content\/uploads\/2026\/07\/What-is-TB-Modifier-in-Medical-Billing-768x461.webp",768,461,true],"large":["https:\/\/medibillmd.com\/blog\/wp-content\/uploads\/2026\/07\/What-is-TB-Modifier-in-Medical-Billing-1024x614.webp",1024,614,true],"1536x1536":["https:\/\/medibillmd.com\/blog\/wp-content\/uploads\/2026\/07\/What-is-TB-Modifier-in-Medical-Billing.webp",1200,720,false],"2048x2048":["https:\/\/medibillmd.com\/blog\/wp-content\/uploads\/2026\/07\/What-is-TB-Modifier-in-Medical-Billing.webp",1200,720,false]},"uagb_author_info":{"display_name":"zeeshan behleem","author_link":"https:\/\/medibillmd.com\/blog\/author\/zeeshan-behleem\/"},"uagb_comment_info":0,"uagb_excerpt":"Did you know that 340B discounted purchases had reached $66 billion during the period 2018 to 2023? Besides, the 340B [&hellip;]","_links":{"self":[{"href":"https:\/\/medibillmd.com\/blog\/wp-json\/wp\/v2\/posts\/6833","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/medibillmd.com\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/medibillmd.com\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/medibillmd.com\/blog\/wp-json\/wp\/v2\/users\/7"}],"replies":[{"embeddable":true,"href":"https:\/\/medibillmd.com\/blog\/wp-json\/wp\/v2\/comments?post=6833"}],"version-history":[{"count":1,"href":"https:\/\/medibillmd.com\/blog\/wp-json\/wp\/v2\/posts\/6833\/revisions"}],"predecessor-version":[{"id":6835,"href":"https:\/\/medibillmd.com\/blog\/wp-json\/wp\/v2\/posts\/6833\/revisions\/6835"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/medibillmd.com\/blog\/wp-json\/wp\/v2\/media\/6834"}],"wp:attachment":[{"href":"https:\/\/medibillmd.com\/blog\/wp-json\/wp\/v2\/media?parent=6833"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/medibillmd.com\/blog\/wp-json\/wp\/v2\/categories?post=6833"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/medibillmd.com\/blog\/wp-json\/wp\/v2\/tags?post=6833"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}