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SHPBN-2016-058 KMAP Roundup Bulletin August 2016

Date: 08/04/16

Updates from the Kansas Medical Assistance Program (KMAP)

  • Non-Coverage of S5131 – Effective with dates of service on and after August 15, 2016, S5131 (home maker services, NOS, per diem) will be a non-covered KMAP service.
  • Services Always Considered Content of Service - Effective with dates of service on and after August 1, 2016, procedure codes listed in KMAP Bulletin 16065, will be denied content of service. This only applies to professional charges.
  • Exclude J2323 from Content of Service Edits – Effective with claims processed on and after August 1, 2016, retroactive to dates of service on and after October 1, 2014, procedure code J2323 (injection, natalizumab, 1 mg) will no longer be content of service. See KMAP Bulletin 16065 for more information.
  • Biosimilar Products – Modifier ZA – Effective with claims processed on and after August 1, 2016, retroactive to dates of service on and after January 1, 2016, procedure code Q5101 (Injection, Filgrastim (G-CSF), Biosimilar, 1 Microgram) must be billed with modifier ‘ZA’ (SANDOZ). Claims billed for Q5101 without modifier ZA will be denied. No retroactive cleanup will be done.
  • Revisions to Diagnosis Group 2017 (Unacceptable Primary Diagnosis Codes) – Effective date of processing of August 1, 2016, and retroactive to date of service on and after October 1, 2015, revisions will be made to Diagnosis Group 2017 (Unacceptable Primary Diagnosis Codes), as listed in Attachment 1 of this policy.  HPE and the MCOs will identify and reprocess denied claims related to Group 2017 mapping. See KMAP Bulletin 16117 for more information.
  • Coverage of Revenue Code 77X (Preventative Care Services) - Approved for immediate implementation on June 29, 2016, Preventative Care Services billed with Revenue Code 77X are covered under KanCare. There is no impact to Providers as Sunflower has covered this code since January 1, 2013.

Sunflower Health Plan receives weekly policy updates from KDHE (KMAP) for implementation of KanCare operations. This monthly bulletin is created and distributed to Sunflower's network partners as a courtesy. 

Providers should regularly access the following web resources for timely updates and detailed guidance: