MedicaidBilling CodesMedium impact
KMAP BULLETIN: High Dollar Rare Disease Drug List Q3 2024 Update
Kansas Medicaid (KanCare)·KS · Oncology, Neurology, Genetics +1 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 for rare disease medications. Facilities must bill procedure code 99199 with modifier U1 ($250 handling fee) for one-time treatments or modifier U3 ($50 handling fee) for repeated administrations, along with required prior authorization and purchasing invoices.
Action Required
Immediately: Update billing system to use CPT 99199 with modifier U1 for one-time rare disease treatments ($250 handling fee) and modifier U3 for repeated administrations ($50 handling fee). Ensure prior authorization is obtained and purchasing invoices are included with all claims for the listed rare disease drugs. Configure system to bill these as outpatient services only.