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KMAP BULLETIN: Enteral Formula Pricing Methodology Change

Date: 07/23/20

KMAP GENERAL BULLETIN 20146 (PDF)

Effective with dates of service on and after September 1, 2020, the manual pricing methodology for enteral nutrition products will be provider cost plus 35%. This will be based on the invoice price.

This applies to the following HCPCS codes for enteral formulas:

  • B4102
  • B4103
  • B4149
  • B4150
  • B4152
  • B4153
  • B4154
  • B4155
  • B4157
  • B4158
  • B4159
  • B4160
  • B4161
  • B4162

Note: The effective date of the policy is September 1, 2020. The implementation of State policy by the KanCare managed care organizations (MCOs) may vary from the date noted in the Kansas Medical Assistance Program (KMAP) bulletins. The KanCare Open Claims Resolution Log on the KMAP Bulletins page documents the MCO system status for policy implementation and any associated reprocessing completion dates, once the policy is implemented.