MedicaidBilling CodesHigh impact
Billing Reminders for Providers Participating in the 340B Program
Illinois Medicaid - HFS·IL · Pharmacy, OB-GYN·Provider Notice
Effective date
Apr 15, 2021
We identified it
Jun 20, 2026
Summary
Illinois providers participating in the 340B drug pricing program must ensure they bill no more than their actual acquisition cost (AAC) plus established dispensing fees when submitting Medicaid claims. Providers found overbilling may face audit referrals and must submit claim adjustments to correct any overpayments.
Action Required
Immediately: Providers participating in 340B program must review all Medicaid drug claims to ensure billing does not exceed actual acquisition cost (AAC) plus $12.00 dispensing fee ($35.00 for certain birth control). Submit claim adjustments to void and rebill any overpayments. Non-pharmacy providers must use Modifier 'UD' with HCPCS codes. Pharmacy providers must populate Submission Clarification Code fields (423-DN = '08' and 420-DK = '20'). Failure to correct overbilling may result in Office of Inspector General audit referral.