MedicaidPrior AuthMedium impact
KMAP BULLETIN: Coverage for Drug Eluted Stents - Hospitals
Kansas Medicaid (KanCare)·KS · Cardiology, Cardiothoracic Surgery·Pharmacy
Effective date
Apr 1, 2025
We identified it
Jun 21, 2026
Summary
Kansas Medicaid (KMAP) will cover specific drug eluted stents for hospitals starting April 1, 2025, but prior authorization is now required. Eight new C-codes are covered with specific reimbursement rates ranging from $6,556.92 to $14,201.21, and patients must have qualifying cardiac diagnoses.
Action Required
Before April 1, 2025: Hospital billing teams must update systems to require prior authorization for drug eluted stent codes C9600-C9608. Verify patients have qualifying cardiac diagnoses listed in policy. Update fee schedules with new Kansas Medicaid reimbursement rates. Ensure procedures are performed at place of service 19, 21, or 22 only. Claims without prior authorization will be denied.