MedicaidBilling CodesHigh impact
KMAP BULLETIN: 2025 Updates to the Medicare Guidelines for Unacceptable Principal Diagnosis Codes
Kansas Medicaid (KanCare)·KS·Provider Bulletin
Effective date
Oct 1, 2024
We identified it
Jun 21, 2026
Summary
Kansas Medicaid has adopted updated Medicare guidelines for unacceptable principal diagnosis codes, effective October 1, 2024. This affects external causes of morbidity, manifestation codes, and other unacceptable primary diagnosis codes that cannot be used as the principal diagnosis on claims.
Action Required
Immediately: Billing team must access the Medicare 'Definition of Medicare Code Edits v42' document from CMS website to review updated list of unacceptable principal diagnosis codes. Update billing system edits to prevent submission of claims with these codes as primary diagnosis. Monitor KanCare Open Claims Resolution Log for MCO implementation dates and reprocessing requirements. Claims submitted with unacceptable principal diagnosis codes will be denied.