MedicaidPrior AuthMedium impact
KMAP BULLETIN: Updated Criteria Guidance for Coverage of Insulin Infusion Pumps and Supplies
Kansas Medicaid (KanCare)·KS · Endocrinology, Family Medicine, Internal Medicine +1 more·Medical Policy
We identified it
Jun 21, 2026
Summary
KMAP (Kansas Medicaid) has updated criteria for insulin pump coverage, requiring prior authorization for Type 1 diabetes patients with specific ICD-10 codes. Pumps are limited to one every three years, must be prescribed by physicians, and all documentation must be submitted by DME providers only.
Action Required
Immediately: Providers treating Kansas Medicaid patients with Type 1 diabetes must ensure prior authorization is obtained before insulin pump placement. Billing team must verify patients have qualifying ICD-10 diagnosis codes (E10.x series) and coordinate with DME providers for all documentation submission to KMAP. Update patient eligibility verification to check for previous pump authorizations within 3-year limit.