MedicaidBilling CodesMedium impact
Reminder-340B Drug Program Billing Policy Change
SC Medicaid - SCDHHS·SC · Oncology, Rheumatology, Infectious Disease +7 more·Pharmacy
Effective date
Apr 1, 2026
We identified it
Jun 18, 2026
Summary
Starting April 1, 2026, South Carolina Medicaid providers who purchase drugs through the 340B program must append the 'TB' modifier to all drug claims and ensure charges don't exceed net acquisition costs for primary Medicaid claims.
Action Required
By April 1, 2026: Billing team must update system to automatically append 'TB' modifier to all 340B drug claims for South Carolina Medicaid members in outpatient settings. Configure billing rules to ensure charges don't exceed net acquisition costs when Medicaid is primary payer. On UB-04 claims with multiple modifiers, ensure TB modifier appears in second position. Update encounter forms and staff training for 340B drug billing procedures.