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340B Drug Program Billing Policy Changes
Act
by Apr 1, 2026
Effective date
Apr 1, 2026
Identified
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.
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What to do
by Apr 1, 2026 · 4 steps
01Billing team must update billing system to automatically append 'TB' modifier to all 340B drug claims.
02For UB-04 claims with multiple modifiers, ensure TB modifier is in second position.
03Update charge entry procedures to limit primary Medicaid 340B drug charges to net acquisition costs only.
04Train staff on new modifier requirements and pricing restrictions.
Original notice
340B Drug Program Billing Policy Changes
scdhhs.gov · Always check the source before changing claims.