MedicaidAdministrativeMedium impact
PT 69-26: Mandatory Use of Submission Clarification Code 20 for 340B MCO Claims
Maryland Medicaid·MD·Pharmacy
Effective date
Mar 1, 2026
We identified it
Jun 18, 2026
Summary
Starting March 1, 2026, pharmacies dispensing 340B drugs to MCO (managed care) patients must include Submission Clarification Code 20 on all claims. This can be submitted in real-time or retrospectively by revising and resubmitting the original claim.
Action Required
By March 1, 2026: Pharmacy billing teams must update billing systems to include Submission Clarification Code 20 on all MCO claims for 340B drugs. Train staff to either submit this code at point of sale in real-time or retrospectively revise and resubmit original claims. Note: This code is NOT required for Medicaid Fee-for-Service claims.