MedicaidBilling CodesMedium impact
Attention All Providers Billing 340B Outpatient Drugs
Nevada Medicaid·NV · Pharmacy, Oncology·Billing & Coding
Effective date
Jul 1, 2022
We identified it
Jun 21, 2026
Summary
Nevada Medicaid is reminding 340B covered entities about billing requirements that went into effect July 1, 2022, for both physician-administered drugs and pharmacy point-of-sale claims. Specific modifiers and codes are required on electronic claims to prevent duplicate discounts between 340B pricing and Medicaid rebates.
Action Required
Immediately: All 340B covered entities must ensure procedure code modifiers are included on 837P and 837I electronic claim transactions for physician-administered drug claims. For pharmacy claims, include Submission Clarification Code 420-DK '20' and Basis of Cost Determination 423-DN '08' on NCPDP electronic transactions when drugs were acquired with 340B pricing. Billing team should review EDI Companion Guides on the Electronic Claims/EDI webpage and consult Nevada Medicaid Pharmacy Billing Manual Appendix A for detailed instructions.