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KMAP BULLETIN: Coverage of Therapeutic Phlebotomy to Treat Polycythemia

Date: 03/03/21

KMAP GENERAL BULLETIN 21028 (PDF)

Effective with dates of service on and after April 1, 2021, Current Procedural Terminology (CPT) code 99195 may be reimbursed when billed with one of the following polycythemia diagnosis codes:

  • D45.0
  • D75.0
  • D75.1
  • P61.1

A new rate will be paid when billed for polycythemia and other previously allowed diagnoses (porphyria, hemochromatosis) related to disorders with iron metabolism.

Note: The effective date of the policy is April 1, 2021, the implementation of State policy by the KanCare Managed Care Organizations (MCOs) may vary from the date noted in the Kansas Medical Assistance Program (KMAP) bulletins. The KanCare Open Claims Resolution Log on the KMAP Bulletins page documents the MCO system status for policy implementation and any associated reprocessing completion dates, once the policy is implemented.