May 01, 2023

Kentucky Medicaid: Home infusion claim requirements

Health care providers who deliver home infusion care to UnitedHealthcare Community Plan of Kentucky Medicaid members must register as both a pharmacy provider (PT 54) and a durable medical equipment (DME) provider (PT 90). 

Specialty pharmacies that bill UnitedHealthcare Community Plan of Kentucky for nursing, administration or supplies must also register as a DME provider (PT 90) with Kentucky Medicaid. 

Billing requirements

  • The provider must bill drugs through the member’s pharmacy benefit using the provider’s pharmacy taxonomy by submitting a claim to the Pharmacy Benefit Manager (MedImpact) at point of service
  • Bill nursing, administration and supplies directly to UnitedHealthcare Community Plan of Kentucky under the member’s medical benefit using the provider’s DME National Provider Identifier (NPI) number and DME provider taxonomy
    • Claims should be billed using a CMS-1500 claim form

When we adjudicate these claims, the provider’s billing NPI and taxonomy will be compared to the Kentucky Medicaid provider enrollment file. The following will result in a claim denial:

  • Claims received with a billing NPI or taxonomy that is not registered with Kentucky Medicaid as a DME Provider Type (PT 90)
  • Nursing, administration or supply claims received using a provider’s pharmacy taxonomy
  • Drugs billed to UnitedHealthcare Community Plan of Kentucky, instead of MedImpact
  • If a CMS-1500 form is received using the pharmacy taxonomy

If nursing, administration or supplies claims are received with the appropriately registered DME taxonomy (PT 90) on the CMS-1500 form, the claim will be forwarded for further adjudication. 


For additional information, please reference the Kentucky Injectable Drug List and the MedImpact prior authorization form.

To submit a prior authorization with UnitedHealthcare

  • Sign in on the UnitedHealthcare Provider Portal Resources page
  • Click on the Prior Authorization tool
  • Select Create a new notification or prior authorization request
  • Enter the required information on the submission site


View the Kentucky Care Provider Manual for additional information or call Provider Services at 800-666-1353.

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