KMAP BULLETIN: Coverage for Drug Eluted Stents - Hospitals

Date: 03/21/25

Effective with dates of service on or after April 1, 2025, the following drug eluted stents will be covered for medical necessary when provided by hospitals (Provider Type/Provider Specialty 01/010) at place of services 19, 21, or 22. Prior authorization is required.

Procedure Code	Outpatient Reibursement Rate
C9600	$8,909.54
C9601	$6,556.92
C9602	$14,201.21
C9603	$6,556.92
C9604	$8,909.54
C9605	$6,556.92
C9606	$13,617.33
C9607	$14,201.21
C9608	$6,556.92

Note: The rates noted in this bulletin may change in the future. Providers should check the Kansas Medical Assistance Program (KMAP) website for the most up-to-date rates.

Diagnosis Requirements:
Members must also have one of the qualifying diagnoses listed below:

I20.0	I20.1	I20.81	I20.89	I20.9	I21.01
I21.02	I21.09	I21.11	I21.19	I21.21	I21.29 S
I21.3	I21.4	I21.9	I21.A1	I21.A9	I22.0
I22.1	I22.2	I22.8	I22.9	I24.0	I24.1
I24.81	I24.89	I24.9	I25.10	I25.110	I25.111
I25.112	I25.118	I25.119	I25.3	I25.41	I25.42
I25.5	I25.6	I25.700	I25.701	I25.702	I25.708 r
I25.709	I25.710	I25.711	I25.712	I25.718	I25.719
I25.720	I25.721	I25.722	I25.728	I25.729	I25.730
I25.731	I25.732	I25.738	I25.739	I25.750	I25.751
I25.752	I25.758	I25.759	I25.760	I25.761	I25.762
I25.768 s	I25.769	I25.790	I25.791	I25.792	I25.798
I25.799	I25.810	I25.811	I25.812	I25.82	I25.83
I25.84	I25.85	I25.89	T82.817A	T82.827A	T82.837A
T82.847A	T82.855A	T82.857A	T82.867A	T82.897A

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.

For changes resulting from this bulletin, view the updated Hospital Fee-for-Service Provider Manual, Section 8400, page 8-26.