KMAP BULLETIN: No Medicaid Coverage for Gender Affirming Care

Date: 10/10/25

Effective for claims processed on or after October 1, 2025, and retroactive to dates of service of February 25, 2025, Kansas Medicaid will implement claims editing requirements to align with Kansas Senate Bill No. 63 and clinical policy determinations. Under this policy, treatments related to gender transition for members aged 20 years and younger are classified as experimental or investigational and are therefore not eligible for coverage.

These changes apply to pharmacy and medical claims for members, specifically targeting certain therapeutic drug classes and diagnosis codes. Claims submitted that do not comply with the policy requirements outlined below will be subject to denial.

Diagnosis Code Required on Pharmacy Claims:

Pharmacy claims for certain androgens, estrogens, progestins, and gonadotropin releasing hormone products will require a valid ICD-10 diagnosis code for claim adjudication.

Claims Denial for Gender Dysphoria-Related Diagnoses:

Claims editing will be applied retroactively to dates of service on or after February 25, 2025, any pharmacy or medical claim that includes a diagnosis code related to the treatment of gender affirming care will be denied when submitted for members aged 20 years and younger.

ICD-10 Diagnosis Codes:

The following diagnosis codes are associated with gender affirming care:

F64.0
F64.1
F64.2
F64.9
Z87.890

Note: The effective dates of the policy are February 25, 2025, and October 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 Pharmacy Fee-for-Service Provider Manual, pages 8-15 and 8-22.