MedicaidCoverageMedium impact
KMAP BULLETIN: Allowance for Pulmonary Rehabilitation Services Update
Kansas Medicaid (KanCare)·KS · Pulmonology·Provider Bulletin
Effective date
Jan 1, 2023
We identified it
Jun 21, 2026
Summary
Kansas Medicaid (KMAP) now covers outpatient pulmonary rehabilitation services when billed by hospitals, with significant rate increases effective August 1, 2024. CPT 94625 increased from $13.71 to $43.22 and CPT 94626 from $20.18 to $47.20, retroactive to January 1, 2023.
Action Required
Immediately: Hospital billing teams must verify they are set up as both billing and rendering provider for pulmonary rehabilitation services with Provider Type/Specialty codes 01/010 or 01/012. Update fee schedules in billing system to reflect new higher rates for CPT 94625 ($43.22) and 94626 ($47.20) effective August 1, 2024. Review and resubmit any denied claims for these services from January 1, 2023 forward. Monitor KMAP website for future rate updates.