MedicaidCoverageMedium impact
KMAP BULLETIN: Coverage of mNEXSPIKE
Kansas Medicaid (KanCare)·KS · Family Medicine, Internal Medicine, General Practice +1 more·Medical Policy
Effective date
Sep 1, 2025
We identified it
Jun 21, 2026
Summary
Kansas Medicaid will now cover mNEXSPIKE (Code 91323) COVID-19 vaccination for members aged 65+ or aged 12-64 with high-risk conditions, effective retroactively to September 1, 2025. Billing varies by age: VFC applies for ages 18 and younger (administration only), while ages 19+ receive reimbursement for both vaccine cost and administration.
Action Required
By September 1, 2025: Update billing system to include mNEXSPIKE code 91323 for Kansas Medicaid COVID-19 vaccinations. Configure age-based billing rules: VFC coverage (administration only) for patients 18 and younger, full vaccine cost plus administration reimbursement for patients 19+. Ensure providers document high-risk conditions for patients aged 12-64. Monitor KMAP website for rate updates and MCO implementation status.