Beginning July 1, 2023, Medicare will begin limiting the patient's out-of-pocket cost to $35 for a month's supply of insulin used in an insulin pump.
Medicare is advising to refrain from billing for supplies of insulin for July 2023 forward before July 2023. Billing early could result in an incorrect payment adjudication. System updates are being made to ensure that patients are not charged for more than the $35 max out-of-pocket cost.
To assist with the transition, Medicare has added 2 new modifiers (JK and JL) and offers the following guidance:
- Before July 2023: For “from date of service” in May or June 2023, don’t bill a 3-month supply of insulin. Instead, bill a 1-month supply of insulin with the JK modifier.
- Starting July 2023: For “from date of service” in July and later, bill a 3-month supply of insulin with the JL modifier or a 1-month supply with the JK modifier.
For additional information, please refer to this MLN Fact Sheet (MLN4443820).