MedicaidCoverageMedium impact
KMAP BULLETIN: Medicaid as Primary Payor of Exempt Formulas
Kansas Medicaid (KanCare)·KS · Pediatrics, Gastroenterology, Genetics +1 more·Provider Bulletin
Effective date
May 1, 2025
We identified it
Jun 21, 2026
Summary
Starting May 1, 2025, Kansas Medicaid (KMAP) will become the primary payer for specialized oral nutrition formulas for children aged 0-4 with metabolic disorders, with WIC becoming secondary. DME providers must submit supplemental billing forms with product invoices and use modifier BO for eligible members.
Action Required
Before May 1, 2025: DME billing team must update procedures to bill KMAP as primary payer for codes B4153, B4157, B4161, B4162 when patients have covered IEM diagnoses and are aged 0-4. Update billing system to add modifier BO for oral nutrition claims. Ensure enteral product supplemental billing forms are submitted with all product invoices for these claims. Claims will be manually priced at provider cost plus 35%.