MedicaidBilling CodesMedium impact
25-1008m Maximize Savings with the Federal 340B Drug Pricing Program
Health Net·CA·Prior Authorization
We identified it
Jun 20, 2026
Summary
Health Net/CalViva Health is reminding providers about the 340B Drug Pricing Program requirements for Medi-Cal beneficiaries. When billing for drugs purchased through 340B pricing, providers must use modifier UD for physician-administered drugs and code '08' in the Basis of Cost Determination field for pharmacy claims to prevent duplicate discounts.
Action Required
Immediately: Billing team must ensure all claims for 340B-purchased drugs include proper modifiers - add UD modifier for physician-administered drugs and use '08' in Basis of Cost Determination field for pharmacy claims. Update billing system rules to automatically prompt for 340B identification when applicable. Verify eligible covered entity status before using 340B pricing.