KMAP BULLETIN: Rate Changes for Physician Administered Drugs – April 2025
Date: 03/03/25
KMAP GENERAL BULLETIN 25023 (PDF)
Effective with dates of service on and after April 1, 2025, Medicaid rates for pure Healthcare Common Procedure Coding System (HCPCS) codes for physician-administered drugs (PADs) will be updated to reflect the Centers for Medicare & Medicaid Services (CMS) Medicare Part B rate updates.
Pricing guidelines for unlisted procedure code drugs will remain the same, Wholesale Acquisition Cost (WAC) based rate. Any HCPCS codes that pertain to drugs on the High Dollar Rare Disease Drug (HD RDD) Reimbursement list will follow the pricing in General Bulletin 24232 for Managed Care Organizations (MCOs).
Should a long-acting reversible contraception (LARC) product have a price change, the updated price will be retroactive to that product’s price change effective date.
Note: The effective date of the policy is April 1, 2025. 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.