MedicaidBilling CodesMedium impact
KMAP BULLETIN: Pharmaceuticals with DME Billing Allowance – Vyjuvek® and Zolgensma®
Kansas Medicaid (KanCare)·KS · Pharmacy·Claims & Billing
Effective date
Jul 1, 2023
We identified it
Jun 21, 2026
Summary
Kansas Medicaid now allows DME providers to bill for Vyjuvek® and Zolgensma® using specific HCPCS codes, with new handling and administration fee billing options. Coverage is retroactive to July 2023 but expires December 31, 2024.
Action Required
Before December 31, 2024: DME providers must update billing systems to allow HCPCS codes J3490 and J3590 for Vyjuvek® and Zolgensma®. Add handling fee billing using 99199 with modifier U1 ($250 for Zolgensma®) or U3 ($50 per dose for Vyjuvek®). Physician offices billing administration only should use 96999 with U1 modifier ($30 per visit). Ensure drug and administration billing occur on same date of service or within 3 days.