MedicaidBilling CodesHigh impact
Professional Claims - Billing Procedure Code 99070 for Dispensing Fee for 340B-Purchased Drugs Effective with Dates of Service Beginning December 1, 2021
Illinois Medicaid - HFS·IL · Family Medicine, Internal Medicine, OB-GYN +1 more·Provider Notice
Effective date
Dec 1, 2021
We identified it
Jun 20, 2026
Summary
Starting December 1, 2021, providers billing 340B-purchased drugs must separate the drug cost from the dispensing fee by using procedure code 99070 for the dispensing fee instead of including it with the drug code. The drug HCPCS code should only include actual acquisition cost with UD modifier, while dispensing fees ($12 non-family planning, $35 family planning) must be billed separately using 99070.
Action Required
Immediately: Billing team must update billing procedures for 340B-purchased drugs to bill dispensing fees separately using CPT 99070 instead of including with drug codes. Update billing system to: 1) Bill HCPCS drug codes with UD modifier for acquisition cost only, 2) Bill 99070 separately for dispensing fees ($12 non-family planning, $35 family planning with FP modifier), 3) Include appropriate unit quantities based on number of unique drug codes. Failure to separate these charges will result in incorrect reimbursement.