MedicaidBilling CodesMedium impact
24-973 Access Lower Drug Pricing Through the 340B Federal Discount Program
Health Net·CA·Pharmacy
We identified it
Jun 20, 2026
Summary
Health Net requires providers participating in the 340B federal discount drug program to use specific billing codes to prevent duplicate discounts. Use UD modifier for physician-administered drugs and 08 in the Basis of Cost Determination field for pharmacy claims when billing for 340B purchased drugs provided to Medi-Cal beneficiaries.
Action Required
Immediately: Billing team must update claim submission process to include UD modifier on all physician-administered drug claims where 340B purchased drugs were used for Medi-Cal beneficiaries. For pharmacy claims, ensure '08' is entered in the Basis of Cost Determination field. Update billing software rules and train staff on identifying 340B eligible entities to ensure proper coding and prevent duplicate discount violations.