MedicaidAdministrativeMedium impact
340B Providers
Illinois Medicaid - HFS·IL · Pharmacy·Provider Notice
Effective date
May 1, 2012
We identified it
Jun 20, 2026
Summary
340B providers enrolled with HRSA must charge HFS (Illinois Medicaid) no more than their actual acquisition cost plus dispensing fee for drugs dispensed to HFS clients. Effective May 1, 2012, providers must use specific modifiers and submission codes to identify 340B purchased drugs on claims.
Action Required
By May 1, 2012: 340B enrolled providers must identify 340B drugs on claims using modifier 'UD' as the first modifier after procedure codes on professional and institutional claims, and use Submission Clarification Code 420-DK with value '20' for pharmacy point-of-sale claims. Billing team must ensure charges do not exceed actual acquisition cost plus dispensing fee ($3.40 for brand, $6.35 for generic).