Traditional MedicareBilling CodesHigh impact
Inflation Reduction Act Impacts Cost Sharing for Medicare Part B Drugs
Healthfirst·Endocrinology, Family Medicine, Internal Medicine +1 more·Provider Update
Effective date
Jul 1, 2023
We identified it
Jun 20, 2026
Summary
The Inflation Reduction Act reduces Medicare Part B coinsurance for drugs with prices increasing faster than inflation, effective April 1, 2023. Starting July 2023, insulin claims with HCPCS codes J1811, J1813, and J1817 must include JK modifier (1-month supply) or JL modifier (3-month supply) or claims will be denied.
Action Required
Immediately: Billing team must update system to require JK modifier (1-month supply) or JL modifier (3-month supply) for all insulin claims using HCPCS codes J1811, J1813, and J1817. Update encounter forms and billing software rules. Claims submitted without these modifiers will be denied.