MedicaidBilling CodesMedium impact
KMAP BULLETIN: UPDATED - High Dollar Rare Disease Drug List Q3 2024 Update
Kansas Medicaid (KanCare)·KS · Oncology, Neurology, Genetics +2 more·Pharmacy
Effective date
Jul 1, 2022
We identified it
Jun 21, 2026
Summary
KMAP updated their High Dollar Rare Disease Drug List for Q3 2024, establishing specific handling fees and billing procedures for expensive rare disease medications. Providers must use procedure code 99199 with modifier U1 ($250 fee) for one-time treatments or modifier U3 ($50 fee) for recurring administrations, along with required prior authorization and purchasing invoices.
Action Required
Immediately: Billing team must update system to use CPT 99199 with modifier U1 for one-time rare disease drug treatments ($250 reimbursement) and modifier U3 for recurring administrations ($50 reimbursement). Ensure prior authorization is obtained and purchasing invoices are submitted with all claims for listed high dollar rare disease drugs. Bill these drugs as outpatient services only.