MedicaidBilling CodesMedium impact
23-1208 Lower Pricing Available to Providers Through 340B Federal Drug Discount Program
Health Net·CA·Pharmacy
We identified it
Jun 20, 2026
Summary
Health Net providers participating in the 340B Federal Drug Discount Program must now use specific modifiers when billing Medi-Cal Rx to prevent duplicate discounts. Physician administered drug claims require the 'UD' modifier, while pharmacy claims need '08' in the Basis of Cost Determination field.
Action Required
Immediately: Billing team must update claim submission procedures for all 340B purchased drugs. For physician administered drug claims, add 'UD' modifier to prevent duplicate discounts. For pharmacy claims, enter '08' in the Basis of Cost Determination field. Update billing software rules and train staff on proper modifier usage. Claims without proper modifiers may result in duplicate discount violations and compliance issues.