MedicaidBilling CodesMedium impact
24-972 Access Lower Drug Pricing Through the 340B Federal Discount Program
Health Net·CA·Pharmacy
We identified it
Jun 20, 2026
Summary
Health Net Community Health Plan of Imperial Valley requires providers to use specific modifiers (UD for physician-administered drugs and 08 for pharmacy claims) when billing for 340B program drugs for Medi-Cal beneficiaries to prevent duplicate discounts and comply with federal law.
Action Required
Immediately: Billing team must update claim submission procedures to include UD modifier for physician-administered drug claims when 340B purchased drugs are 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. Failure to use correct modifiers may result in duplicate discount violations and compliance issues.