MedicaidBilling CodesMedium impact
25-1009m Maximize Savings with the Federal 340B Drug Pricing Program
Health Net·CA·Prior Authorization
We identified it
Jun 20, 2026
Summary
Health Net requires providers to use code 340B with modifier UD08 for physician-administered drugs purchased through the Federal 340B Drug Pricing Program to access discounted rates and comply with Medi-Cal requirements. This applies specifically to eligible covered entities like qualifying hospitals, HRSA grantees, and safety net providers in Imperial County.
Action Required
Immediately: Billing team must identify if practice qualifies as a 340B covered entity (qualifying hospitals, HRSA grantees, CDC, safety net providers). If eligible, update billing system to use code 340B with modifier UD08 for physician-administered drugs purchased through 340B program when treating Medi-Cal beneficiaries. Add UD modifier to all physician-administered 340B drugs and use '08' in Basis of Cost Determination field for pharmacy claims to ensure proper rebate exclusion.