Kansas Medicaid (KMAP) asks for form 60-14 on claims that need medical documentation. The prescribing provider lists the procedure code, the item or service prescribed and the date, the diagnosis and prognosis, the reason for the equipment, appliance, supplies or procedure, and an estimate in months of how long equipment is needed, then certifies it was medically necessary.
The prescribing provider completes and signs the whole certificate, adding provider name and number. The provider who bills attaches it to the claim, so a supplier may need to request it from the prescriber.
Download the current version from the source each time; forms change without notice.
Certificate of Medical Necessity
A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms and their requirements change without notice, so check the official page for the current version before you complete one.
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When a Kansas Medicaid claim requires medical documentation, the form says to attach the certificate to it. The prescribing provider documents the item or service, diagnosis, prognosis and reason it was prescribed. It is not used for sterilizations or hysterectomies, which have their own consent forms.
The prescribing provider signs and dates it and adds provider name and number. By signing, the provider certifies that the service or supply was prescribed as medically necessary to alleviate or improve the condition or diagnosis entered on the form. The billing provider then attaches it to the claim.
The patient's name and Medicaid number, billing date, procedure code, a description of the item or service prescribed and the date prescribed, the diagnosis and prognosis, the reason for the equipment, appliance, medical supplies or procedure, and an estimate in months of how long the equipment will be needed.