MedicaidBilling CodesMedium impact
340B Drug Program Billing Policy Changes
SC Medicaid - SCDHHS·SC·Pharmacy
Effective date
Apr 1, 2026
We identified it
Jun 18, 2026
Summary
South Carolina Medicaid requires providers to append the 'TB' modifier to all claims for drugs purchased through the 340B program, effective April 1, 2026. For primary Medicaid claims, charges cannot exceed net acquisition costs, while secondary Medicaid claims may use usual charges but must include the TB modifier.
Action Required
By April 1, 2026: Billing team must update billing system to automatically append 'TB' modifier to all 340B drug claims. For UB-04 claims with multiple modifiers, ensure TB modifier is in second position. Update charge entry procedures to limit primary Medicaid 340B drug charges to net acquisition costs only. Train staff on new modifier requirements and pricing restrictions.