Traditional MedicareBilling CodesMedium impact
KMAP BULLETIN: VYJUVEK BILLING GUIDANCE
Kansas Medicaid (KanCare)·KS · Dermatology, Genetics, Wound Care·Claims & Billing
Effective date
Jul 31, 2023
We identified it
Jun 21, 2026
Summary
Kansas Medicaid has issued new billing guidance for Vyjuvek (gene therapy), establishing specific HCPCS coding requirements that vary by payer type and date of service. For services from 7/31/2023-12/31/2023, use unclassified codes J3490/J3590, but starting 1/1/2024, use the new dedicated code J3401 with different unit calculations and waste reporting requirements for Medicare vs Medicaid.
Action Required
Immediately: Update billing system to use correct HCPCS codes for Vyjuvek based on date of service and payer. For dates 7/31/2023-12/31/2023, use J3590 with JZ modifier (1 unit, no waste). For dates 1/1/2024 forward, use J3401: Medicare requires 2 lines totaling 25 units (administered amount + JW modifier for waste), Medicaid requires 1 line with 25 units (no JW modifier). Train billing staff on NDC 82194051002 requirements and proper unit calculations for 0.8ML vs 1.6ML doses.