MedicaidAdministrativeMedium impact
Basis of Cost Determination field Required for drugs purchased udner the 340B Discount Program when billing the following programs: MMPP, KDP, BCCDT, and Hospital Presumptive Eligibility
Maryland Medicaid·MD · Pharmacy·Provider Transmittal
Effective date
Nov 1, 2014
We identified it
Jun 20, 2026
Summary
Effective November 1, 2014, pharmacies dispensing 340B Program drugs must enter '08' in the Basis of Cost Determination field (423-DN) when billing Maryland Medicaid programs (MMPP, KDP, BCCDT) and Hospital Presumptive Eligibility to prevent duplicate discount claims. The policy also introduces Hospital Presumptive Eligibility providing temporary 60-day coverage that requires eligibility verification through EVS.
Action Required
By November 1, 2014: Pharmacy billing staff must update billing systems to automatically enter '08' in the Basis of Cost Determination field (423-DN) for all 340B Program drugs when submitting claims to Maryland Medicaid programs (MMPP, KDP, BCCDT) and Hospital Presumptive Eligibility. Train staff to verify HPE eligibility through EVS system when patients present HPE Approval Notices instead of regular Medicaid cards.