MedicaidBilling CodesHigh impact
340B Drug Program Billing Policy Changes
SC Medicaid - SCDHHS·SC·Pharmacy
Effective date
Dec 1, 2025
We identified it
Jun 18, 2026
Summary
Starting December 1, 2025, South Carolina providers purchasing drugs through the 340B program must include the 'TB' modifier on all Medicaid fee-for-service claims and ensure their billing numbers are on the HRSA Medicaid Exclusion file. The TB modifier must be in the second position on UB-04 claims with multiple modifiers.
Action Required
By December 1, 2025: Billing team must update billing systems to automatically include 'TB' modifier on all 340B drug claims for South Carolina Medicaid fee-for-service patients. Ensure TB modifier appears in second position on UB-04 claims with multiple modifiers. Verify provider's NPI and state billing numbers are listed on HRSA Medicaid Exclusion file. Confirm billed amounts do not exceed actual acquisition costs. Contact Provider Service Center at (888) 289-0709 with questions.