KMAP BULLETIN: Immunization Administration by Pharmacy Providers
Date: 06/07/24
KMAP GENERAL BULLETIN 24103 (PDF)
Effective with dates of service on and after June 1, 2024, all pharmacy vaccine and pharmacist vaccine administration services must be billed on a professional claim using the pharmacy and pharmacist National Provider Identifier (NPI) and taxonomy code as defined below:
Provider Role | NPI | Taxonomy |
Billing | Type-2 NPI: Pharmacy (32/240) | 333600000X |
Rendering | Type-1 NPI: Pharmacist (32/276) | 1835P0018X |
The Kansas Medical Assistance Program (KMAP) recommends submitting the taxonomy information on pharmacy vaccines and pharmacist vaccine administration services for effective claims processing. Claims may be denied for provider NPI crosswalk if any of these fields (NPI or taxonomy) are missing.
Pharmacy and Pharmacist Provider Type/Provider Specialty Requirements Effective June 1, 2024:
Providers must be enrolled as a Provider Type/Provider Specialty (PT/PS) of 32/240 (pharmacy) and 32/276 (pharmacist) to be eligible for reimbursement. Refer to the KMAP Updated General Bulletin 23196 for enrollment requirements and billing guidelines for pharmacy and pharmacist enrollment and professional claim billing.
Discontinuation of DME (25/255) Billing Provisions:
Effective with dates of service on and after June 1, 2024, pharmacy providers will no longer be allowed to bill vaccines under the Durable Medical Equipment (DME) benefit as PT/PS 25/255.
KanCare Managed Care Organizations (MCOs) will no longer allow billing for influenza vaccines through the pharmacy benefit.
Covered Vaccine and Vaccine Administration Services:
The vaccine and vaccine administration procedure codes will continue to be considered for coverage with the current benefits and limitations. However, the new PT/PS pharmacy and pharmacist billing requirements must be followed.
Additional Billing Guidelines:
Refer to the guidelines below for accurate billing of NPI and taxonomy codes:
| Provider Role | 837P Electronic | CMS-1500 Paper |
|---|---|---|
| Billing | NPI: 2010AA NM109 Taxonomy: 2000A PRV03 | NPI: Field 33a Taxonomy: Field 33b
|
| Rendering | Header Level: NPI: 2310B NM109 Taxonomy: 2310B PRV03 Detail Level: NPI: 2420A NM109 Taxonomy: 2420A PRV03 | NPI: Field 24J (bottom section) Taxonomy: Field 24J (top section) |
Note: The effective date of the policy is June 1, 2024. The implementation of State policy by the KanCare MCOs may vary from the date noted in the 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.