Skip to main content
  • Medicaid Provider Alert: Provider revalidation has begun and those not completing the process risk disenrollment.  Check your account now to learn when your revalidation is due. More information here.
Elizabeth M. Whitehorn, Director

Provider Notice issued 04/24/13

Dispensing Fee Add-on for Certain Birth Control Methods

To:​ Participating Advanced Practice Nurses, Local Education Agencies (LEAs), Local Health Departments, School Based/Linked Health Centers and Physicians​
​Date: ​April 24, 2013
​Re: Dispensing Fee Add-on for Certain Birth Control Methods​

The purpose of this notice is to advise providers of a new dispensing fee add-on that will be applied to highly effective birth control methods purchased through the 340B federal Drug Pricing Program.

Effective with dates of service July 1, 2012, and after, the following birth control methods purchased through the 340B program will receive a $20 dispensing fee add-on:

HCPCS

Birth Control Method
A4266

Diaphragm for contraceptive use
J1050

(effective 1/1/2013) Injection, medroxyprogesterone acetate for contraceptive use (Depo Provera)
J1055

(prior to 1/1/2013) Injection, medroxyprogesterone acetate for contraceptive use (Depo Provera)
J3490

(effective 2/11/2013) Levonorgestrel-releasing Intrauterine Device 13.5mg Skyla (must include the name of the item in the note/description field)
J7300

Copper Intrauterine Device (Paragard)
J7302

Levonorgestrel-releasing Intrauterine Device, 52mg (Mirena)
J7303

Vaginal ring (Nuvaring)
J7304

Contraceptive Patch (Ortho Evra)
J7307

Etonogestrel Implant (Implanon)
S4993

Oral contraceptives, including emergency contraceptive pills (i.e., Plan B)

In order to receive the $20 dispensing fee add-on, providers must identify 340B purchased drugs by reporting modifier "UD" in conjunction with the appropriate procedure code and actual acquisition cost for the birth control method. Providers should not add the dispensing fee to their cost. The department will add the $20 dispensing fee to the provider's final reimbursement.

The department is finalizing the programming necessary to pay the new dispensing fee. Once programming is completed, the department will process a separate adjustment for any 340B claims properly billed and adjudicated by the department retroactive to July 1, 2012.

Questions regarding this notice may be directed to the Bureau of Comprehensive Health Services at 1-877-782-5565.

Theresa A. Eagleson, Administrator

Division of Medical Programs