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KMAP BULLETIN: No Medicaid Coverage for Gender Transition Surgical Care – 0-20 Years

Date: 10/10/25

KMAP GENERAL BULLETIN 25224 (PDF)

This bulletin serves to inform providers of new statutory requirements and restrictions mandated by Senate Bill 63 (SB63) regarding coverage of gender-affirming health care services under Kansas Medicaid. These changes impact the reimbursement and coverage of certain procedures and services provided to individuals under the age of 21.

Coverage Restrictions for Minors Under Age 18 (Effective February 25, 2025):

Pursuant to Senate Bill 63, and effective for dates of service on or after February 25, 2025, Kansas Medicaid shall not reimburse or provide coverage for gender-affirming health care provided to individuals under 18 years of age if performed:

  • For the purpose of presenting as a member of the opposite sex, or
  • As a treatment for a child whose perceived gender or sex is inconsistent with their biological sex assigned at birth.
  • This restriction includes, but is not limited to, the surgical procedures listed in SB63, Section 3(a)-(b), based on biological sex.


Coverage Restrictions for Individuals Ages 18 to 20 (Effective June 1, 2025):

Effective for dates of service on or after June 1, 2025, Kansas Medicaid shall not reimburse or provide coverage for surgical treatment performed on individuals ages 18 through 20 when:

  • The surgical treatment is provided for the purpose of treating gender dysphoria or distress related to the perception that an individual’s gender is inconsistent with their biological sex.
  • These procedures are considered experimental by the State of Kansas under the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) program guidelines.

Claims Processing:

  • If a claim is billed with any of the diagnosis codes listed below, in any position, the claim will be suspended for manual review. Providers may submit appropriate documentation such as medical records for the manual review.
    • F64.0
    • F64.1
    • F64.2
    • F64.8
    • F64.9
    • Z87.890

Contested denials will require the submission of pertinent medical records and clinical documentation to support medical necessity or to determine if an exception applies (see the listed exceptions below).

Exceptions to Coverage (Ages 0-20):
Under SB63 and Kansas Medical Assistance Program (KMAP) policy, exceptions may apply in the following circumstances:

  • Treatment of individuals with a medically verifiable disorder of sex development, including:
    • Ambiguous biological sex characteristics (e.g., 46 XX with virilization, 46 XY with under-virilization).
    • Diagnoses confirmed by genetic or biochemical testing showing atypical sex chromosome structure or hormone production.
  • Treatment of infection, injury, disease, or disorder caused or exacerbated by a previously performed prohibited procedure.

Providers are encouraged to review SB63 in full and adjust  treatment and billing practices accordingly. Please contact your  Managed Care Organization (MCO) or the KMAP line with questions regarding claim processing or medical necessity  documentation.

Note: The effective dates of the policy are February 25, 2025, and June 1, 2025. 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.