KMAP BULLETIN: Coverage of mRNA RSV Vaccine mResvia

Date: 05/06/25

Effective with date of service and retroactive to June 26, 2024, Kansas Medicaid will cover the messenger ribonucleic acid (mRNA) Respiratory Syncytial Virus (RSV) vaccine mResvia for adults aged 60 years and older.

Code	Rate
90683	$290.00

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

The Advisory Committee on Immunization Practices (ACIP) recommends mResvia RSV vaccination for all the adults aged 75 years and older and for the adults aged between 60-74 years who are at increased risk of severe RSV disease.

Adults aged 60 years or older who are at increased risk for severe RSV disease include:

Those with chronic medical conditions such as lung diseases (e.g., chronic obstructive pulmonary disease, asthma), cardiovascular diseases (e.g., congestive heart failure, coronary artery disease), neurologic or neuromuscular conditions, kidney disorders, liver disorders, hematologic disorders, diabetes mellitus, and moderate or severe immune compromise (either attributable to a medical condition or receipt of immunosuppressive medications or treatment).
Those who are considered to be frail.
Those of advanced age.
Those who reside in nursing homes or other long-term care facilities.
Those with other underlying medical conditions or factors that a health care provider determines might increase the risk of severe respiratory disease.

Note: The effective date of the policy is June 26, 2024. The implementation of State policy by the KanCare Managed Care Organizations (MCOs) may vary from the date noted in the 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.