MedicaidBilling CodesMedium impact
24-971 Access Lower Drug Pricing Through the 340B Federal Discount Program
Health Net·CA·Pharmacy
We identified it
Jun 20, 2026
Summary
Health Net/CalViva Health requires providers to use specific modifiers when billing for drugs purchased through the 340B federal discount program to prevent duplicate discounts. Physician-administered drugs need the 'UD' modifier and pharmacy claims need '08' in the Basis of Cost Determination field for Medi-Cal beneficiaries.
Action Required
Immediately: Billing team must update claim submission procedures to include 'UD' modifier for all physician-administered drugs purchased through 340B program for Medi-Cal patients. Update pharmacy billing to include '08' in Basis of Cost Determination field for 340B purchased drugs. Train staff to identify 340B eligible entities and ensure proper modifier usage to prevent claim processing issues.