MedicaidAdministrativeMedium impact
Reminders for Billing Outpatient Drugs for 340B-Covered Entities
Nevada Medicaid·NV·Billing & Coding
We identified it
Jun 21, 2026
Summary
Nevada Medicaid is reminding providers of existing billing requirements for 340B drug program claims that have been in effect since July 1, 2022. Providers must use specific modifiers on physician-administered drug claims and specific codes on pharmacy point-of-sale claims when drugs are acquired through the 340B discount program.
Action Required
Immediately: Billing team must verify that physician-administered drug (PAD) claims include required procedure code modifiers on 837P and 837I electronic transactions when drugs are acquired through 340B program. For pharmacy point-of-sale claims, ensure Submission Clarification Code '20' (420-DK) and Basis of Cost Determination '08' (423-DN) are included on NCPDP electronic transactions. Review updated EDI Companion Guides on Nevada Medicaid's Electronic Claims/EDI webpage to confirm proper implementation.