MedicaidCoverageMedium impact
KMAP BULLETIN: Coverage of Clesrovrimab (Enflonsia)
Kansas Medicaid (KanCare)·KS · Pediatrics, Family Medicine·Medical Policy
Effective date
Aug 4, 2025
We identified it
Jun 21, 2026
Summary
Kansas Medicaid will begin covering Clesrovimab (Enflonsia), a monoclonal antibody to prevent RSV in infants under 8 months old, effective August 4, 2025. The drug will be covered through the VFC program with Kansas Medicaid reimbursing only the administration at $20.26 using specific CPT codes.
Action Required
Before August 4, 2025: Billing team must update system to include new RSV monoclonal antibody CPT code 90382 for Clesrovimab (Enflonsia) and ensure administration codes 96380 or 96381 are set to reimburse at $20.26 for Kansas Medicaid patients. Update encounter forms for pediatric providers treating infants under 8 months old. Note that the drug itself will be covered through VFC program - only bill for administration.