KMAP BULLETIN: COVID-19 Test Kit Coverage

Date: 03/16/22

KMAP GENERAL BULLETIN 22031 (PDF)

Effective on and after March 1, 2022, COVID-19 test kits, Overthe-Counter (OTC) and prescription-only, are a covered service. There will be a limit of four kits, or eight tests per 30 rolling days. Multi-pack kits greater than eight tests per kit are not covered. The following in-home antigen COVID-19 tests are approved for reimbursement:

Covid-19 Test	National Drug Code (NDC)
BinaxNow	11877001133
BinaxNow	11877001140
CareStart	50010022431
Ellume	56964000000
FlowFlex	82607066026
IHealth	56362000589
InteliSwab	8337000158
Quickvue	14613033968
Quickvue	14613033972

Medicaid reimbursement will be up to $12.50 per test, and $25.00 for a box of two tests. 

Billing Method for Members not assigned to an MCO: Pharmacies must be enrolled as a Durable Medical Equipment (DME) provider and utilize their DME National Provider Identifier (NPI) to bill for members not assigned to an MCO. They may use their DME NPI as the referring/ordering provider on the Centers for Medicare and Medicaid Services (CMS) 1500 Claim Form, or its equivalent, utilizing HCPCS code T5999 with modifier U3. Providers are to bill one unit for each test, regardless of how they are boxed. There will be no cost-sharing obligations, excluding spenddown, until further notice. Claims submitted with a diagnosis code of B9729 or U071 will be exempt from co-pay.

Billing Method for Members assigned to an MCO: Pharmacies should bill these claims via point of sale (POS) using their pharmacy NPI and the appropriate NDC. Pharmacies can list their NPI as the prescribing provider for pharmacy claim billing. 

Note: The effective date of the policy is March 1, 2022. 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.