340B Drug Program Reimbursement Calculator

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Enter ASP Fee:

  
 

 


All items below must be true.

  • Facility is reimbursed under Outpatient Prospective Payment System (OPPS)
  • Drug has a status indicator K
  • Drug being subject to Average Sales Price (ASP) + 6% reimbursement methodology
  • Line-item billed with modifier JG

Calculator Use

  • Select appropriate drug pricing year and quarter file for dates of service billed
  • Enter amount into ASP field
  • Calculator will return single unit reimbursement amount

Calculator Exceptions

Items below are not considered when calculating reimbursement:

  • Patient responsibility
  • Sequestration
  • Other primary payer
  • If drug is reimbursed under other methodology besides ASP + 6%

Calculation Explanation

Calculator equation is set to:

  • (X/1.06) * 0.775 = reimbursement
    • X is ASP dollar amount, which includes a 6% markup
    • 1.06 is markup value
    • 0.775 leaves amount of reimbursement left (as opposed to calculating reduction, which would have used 0.225)

Still have questions on reimbursement? Call the Noridian Provider Contact Center.

 

Last Updated Thu, 06 Sep 2018 11:36:32 +0000