MedicaidCoverageMedium impact
KMAP BULLETIN: Pentavalent Meningococcal Penbraya Vaccine Coverage
Kansas Medicaid (KanCare)·KS · Family Medicine, Pediatrics, Infectious Disease +2 more·Medical Policy
Effective date
Jan 1, 2024
We identified it
Jun 21, 2026
Summary
Kansas Medicaid will now cover the new pentavalent meningococcal vaccine Penbraya (CPT 90623) at $230.00 for eligible patients aged 10+ with specific risk factors. This provides a single-dose alternative to separate MenACWY and MenB vaccines when both are indicated.
Action Required
Immediately: Update billing system to include CPT 90623 for Penbraya vaccine at $230.00 for Kansas Medicaid patients. Use administration codes 90460 (≤18 years, $20.26 VFC fee) or 90471 (≥19 years, $14.15 fee). Add code 90472 for each additional vaccine. Update encounter forms to identify eligible patients with complement deficiencies, asplenia, sickle cell disease, or microbiologists exposed to Neisseria meningitidis.