Reimbursement Policy: Modifier TB requirement

Effective November 1, 2025, Blue Cross and Blue Shield of North Carolina (Blue Cross NC) is implementing a revision to the Drugs and Biologicals reimbursement policy.

Consistent with CMS, Blue Cross NC will require outpatient drugs purchased under the 340b program to be billed using Modifier TB. The modifier must be submitted for each applicable claim line. Blue Cross NC is making this change to ensure accurate and consistent coding and reimbursement for drugs and biologicals acquired through the 340B drug program.

Please see the related policy notification for more information.

This new policy will apply to Commercial, Inter-Plan Program (IPP) Host, Medicare Advantage (MA), and Federal Employee Program^® (FEP). This will not apply to IPP Home.