MedicaidBilling CodesHigh impact
KMAP BULLETIN: Carve Out Drugs – Hospital Billing Guidelines
Kansas Medicaid (KanCare)·KS · Oncology, Hematology, Transplant Surgery·Claims & Billing
Effective date
Oct 18, 2024
We identified it
Jun 21, 2026
Summary
Kansas Medicaid has designated 15 high-cost drugs (≥$100,000/year) as 'Carve Out Drugs' that must be billed as outpatient claims rather than included in inpatient DRG payments. These specialty drugs, including CAR-T cell therapies and gene therapies, require separate billing with invoice documentation and are excluded from standard hospital reimbursement methodology.
Action Required
Immediately: Hospital billing teams must identify patients receiving any of the 15 listed Carve Out Drugs (Abecma, Aucatzyl, Breyanzi, Carvykti, Casgevy, Kebilidi, Kymriah, Lenmeldy, Lyfgenia, Ryoncil, Skysona, Tecartus, Yescarta, Zevaskyln, Zynteglo) and bill as outpatient claims with complete drug invoices attached. Update billing system to exclude these drug costs from inpatient DRG calculations. Claims without clear, readable invoices will be denied. This applies retroactively to dates specified for each drug.