MedicaidAdministrativeMedium impact
KMAP BULLETIN: New Provider Specialty for Provider Type 32
Kansas Medicaid (KanCare)·KS · Pharmacy·Network
Effective date
Jan 1, 2026
We identified it
Jun 21, 2026
Summary
Kansas Medicaid (KMAP) is creating a new provider specialty (PS 243) under Provider Type 32 for pharmacies to bill physician-administered drugs using HCPCS codes under the medical benefit instead of pharmacy benefit. Eight specific drugs including Zolgensma and Tepezza will transition from pharmacy/DME billing to this new medical billing structure effective January 1, 2026.
Action Required
Before January 1, 2026: Pharmacies providing physician-administered drugs must obtain a new NPI and enroll as 'Facility' under Provider Type 32, Specialty 243 using taxonomy code 333600000X. Update billing systems to process the eight listed drugs (Amondys 45, Exondys 51, Vyondys 53, Tepezza, Zolgensma, Vyjuvek, Livmarli, Voxzogo) under medical benefit using HCPCS codes rather than pharmacy benefit. Ensure pharmacy is listed as both performing and billing provider on all claims for these drugs.