---
title: "KanCare (Kansas Medicaid) ABA coverage: the intake guide."
url: "https://carelu.com/payers/kansas-medicaid"
markdown_url: "https://carelu.com/payers/kansas-medicaid.md"
state: KS (Kansas)
payer: KanCare (Kansas Medicaid)
kind: State Medicaid program
description: "How KanCare (Kansas Medicaid) covers ABA under EPSDT as two services — CCTS and IIS — through three MCOs: prior authorization, the 6-month diagnosis-validation rule, the 50 hr/yr and 25 hr/wk soft limits, KMAP enrollment, and the honest rate picture."
last_reviewed: September 2026
vob_data_updated: 2026-07-23
---

# KanCare (Kansas Medicaid) ABA coverage: the intake guide.

_Payer Guide · KanCare · Last updated September 2026 · 17 primary sources_

> CCTS + IIS under EPSDT (not "ABA"); 3 MCOs, 6-month diagnosis rule, 50 h/yr + 25 h/wk limits.

Kansas Medicaid doesn't call it ABA. Since January 1, 2017, the benefit lives in the State Plan under EPSDT as two "Autism Services": Consultative Clinical and Therapeutic Services (CCTS) — the BCBA-level tier covering assessment, treatment planning, supervision, and family training — and Intensive Individual Supports (IIS), the technician-level 1:1 tier. Understanding that vocabulary is half the intake battle, because authorizations, provider enrollment, and limits are all organized around the CCTS/IIS split. Delivery runs entirely through KanCare's managed care organizations — Sunflower Health Plan, UnitedHealthcare Community Plan, and (since January 1, 2025) Healthy Blue Kansas — with KMAP fee-for-service policy as the baseline underneath. Aetna Better Health of Kansas is gone: it lost the KanCare 3.0 contract and its members moved to Healthy Blue on 1/1/2025.

## Prior authorization and diagnosis at a glance

- **Prior auth for the assessment**: Required — physician/licensed-practitioner recommendation + PA per KMAP Bulletin 17129; each MCO runs its own intake [1]
- **Prior auth for treatment**: Required — CCTS soft limit 50 hrs/year, IIS initially authorized up to 25 hrs/week; MCO reauthorization at minimum every 6 months [4][16][1]
- **Autism diagnosis required?** _(plan-dependent)_: Yes — ASD (F84.x); both major MCOs require MD/licensed-psychologist validation within the last 6 months; EPSDT age 20 and under. Per KMAP Bulletin 26140 (eff. 11/1/2026), for members 20 and under the diagnosis must additionally come from a Kansas BSRB-licensed clinical psychologist or a qualified physician, documented against DSM criteria/severity with a validated tool (e.g., ADOS, CARS) — a 2-year grace period applies to members already diagnosed by a non-compliant provider. [2][16][17]
  - Ask the plan: Unresolved conflict, not a missing document: KMAP Bulletin 26140 (reissued 8/31/2026, eff. 11/1/2026) says a member diagnosed by a qualified diagnostician is eligible for ABA "without the need for a re-evaluation" and with "no time limit," while Sunflower KS.CP.01 (last reviewed 06/2019) still requires an MD or licensed psychologist to have validated the diagnosis within the last 6 months. Ask the member's MCO (Sunflower, UnitedHealthcare/Optum or Healthy Blue) which rule its UM team applies at initial authorization.

## At a glance

- **Covers ABA?:** Yes — as CCTS + IIS under EPSDT, members age 20 and under
- **Prior auth:** Required — physician/practitioner recommendation + PA, per MCO
- **Hour limits:** CCTS soft limit 50 hrs/year; IIS initial auth up to 25 hrs/week (more on medical necessity)
- **Diagnosis recency:** ASD validation within the last 6 months (Sunflower + Optum/UHC rule)
- **Diagnosing credential (new 11/1/2026):** KMAP Bulletin 26140 — BSRB-licensed clinical psychologist or qualified physician, DSM criteria + validated tool (ADOS/CARS); 2-yr grace period for existing non-compliant diagnoses
- **Administered by:** Sunflower, UHC Community Plan, Healthy Blue (all MCO, contracts 2025–2027)
- **Licensure:** Kansas LBA/LaBA (BSRB) since 7/1/2016; every provider needs their own KMAP ID
- **Rates:** Not reliably published — KMAP interactive lookup is the source of truth (last verified rate action 4/1/2019)
- **Staff screening:** Five-part enrollment check: KBI + APS/CPS registries + Nurse Aide Registry + motor-vehicle screen (every CCTS/IIS applicant)

## Kansas doesn't call it ABA: CCTS + IIS

ABA moved from the old HCBS Autism waiver into the Medicaid State Plan under EPSDT effective January 1, 2017, split into two services. CCTS ("Autism Specialist Services," provider type 11, specialty 403) is the analyst tier — billed under 97151, 97152, 97155, and 97156 — and carries an approved soft limit of 50 hours per year. IIS (specialty 404) is the technician-delivered 1:1 tier billed under 97153, initially authorized up to 25 hours per week with additional hours available on medical necessity. Effective 7/1/2024 the billing map widened: CCTS may also bill 97153, 97154, and 97158, and IIS may also bill 97154. A separate small HCBS Autism waiver still exists for very young children. [1][4][6]

Kansas also has unusual non-certified provider pathways: CCTS can be delivered by a master's-level professional with a KDADS HCBS director letter plus state-approved training, and IIS by a non-RBT with a high-school diploma, 40 hours of ABA training, and a KDADS validation letter, supervised by a BCBA. But the credentialing bottleneck to plan around is KMAP enrollment: every group AND every individual provider — each BCBA and each RBT — must be screened and enrolled in KMAP with their own KMAP ID before any MCO can pay them, and each service location requires separate enrollment. [1][4][6]

## The KanCare 3.0 MCO landscape

KanCare is comprehensive statewide managed care — effectively all ~458,000 beneficiaries sit with one of three MCOs under contracts running 1/1/2025 through 12/31/2027 (renewable to 2029): Sunflower Health Plan (Centene), UnitedHealthcare Community Plan (behavioral health via Optum), and Healthy Blue Kansas, the new entrant. Aetna Better Health of Kansas, which served KanCare 2019–2024, was not selected — its members auto-transitioned to Healthy Blue on 1/1/2025 unless they chose Sunflower or UHC. Any directory still listing Aetna Better Health as an active KanCare plan is stale. PA and payment run through the MCOs with KMAP FFS policy as the floor; a secondary source reports KanCare MCOs must pay in-network providers at least 100% of the FFS rate (we could not verify this against the contract itself). [7][15]

## Authorization & the 6-month diagnosis rule

At the state-policy level, CCTS — which includes the assessment function, now billed 97151 — requires a recommendation by a physician or other licensed practitioner and is subject to prior authorization; each MCO operates its own PA intake. The tripwire to design intake around is diagnosis recency: both Sunflower (KS.CP.01) and Optum/UHC (BH 803ABA Kansas entry) require that an MD or licensed psychologist has validated the ASD diagnosis via comprehensive diagnostic evaluation within the last 6 months at initial authorization — an unusually aggressive rule that means a two-year-old diagnostic report doesn't clear the gate. Reauthorization runs at minimum every 6 months (Optum layers a monthly provider progress review on top), and Sunflower adds its own Kansas-specific gate: a current Kan Be Healthy (EPSDT) screen within the past year. Capture diagnosis date and screening status at first contact, not at submission. [1][16][17][2]

KMAP Bulletin 26140, issued 8/12/2026 and reissued 8/31/2026, effective 11/1/2026, layers a credential requirement on top of that 6-month currency rule rather than replacing it: for members age 20 and under, the ASD diagnosis itself must come from a Kansas BSRB-licensed clinical psychologist or a qualified physician (family/general practice, neurology, psychiatry, pediatrics, and similar specialties), documented against DSM criteria and severity level using a validated diagnostic tool such as ADOS or CARS. Members already diagnosed by a non-compliant provider get a 2-year grace period before the new rule bites — worth flagging to families with an older diagnostician on file so a re-evaluation isn't a surprise at the 2028 mark. [1][16][17][2]

## Rates: a 2019 anchor, not a current schedule

We won't quote current Kansas autism-services rates, because we couldn't verify them. The last public anchor is the CPT crosswalk effective 1/1/2019, which set 97151 at $17.50 per 15-minute unit — and that was then raised effective 4/1/2019 by a bulletin that did not publish the new amounts. Notably, the 7/1/2022 behavioral-health rate increase did NOT include the 9715x autism codes. The source of truth is the KMAP interactive fee-schedule lookup (Reference Codes on the KMAP portal); UHC/Optum explicitly commits to reimbursing at the Kansas Medicaid autism-services rates, so the KMAP lookup doubles as your MCO benchmark. Treat any dollar figure circulating for Kansas ABA as unverified until you've pulled it from that lookup yourself. [3][4][5]

## Staffing & credentialing: who you can hire, and what they must clear

Kansas is one of the few states where RBT certification is genuinely optional for Medicaid work. Since April 3, 2020, IIS technicians (KMAP type 11, specialty 404, billing 97153) qualify one of two ways: hold an RBT certificate, or complete the state-equivalent pathway — age 18+, high-school diploma or equivalent, 40 hours of ABA training including 8 hours of supervised intervention work and 3 hours of ethics (plus at least 1 hour each in criterion-referenced assessment, social skills, parent training, and program development), an initial competency assessment, and an acceptance letter from the KDADS HCBS Autism Program Manager or HCBS Director. That letter is individually issued, so it adds onboarding lead time; either track requires annual training to stay qualified. Technicians don't need a BSRB license — K.S.A. 65-7503 expressly exempts autism specialists and IIS providers under the state autism program from behavior analyst licensure. If you hire on the RBT track, the BACB's own floor still applies: the 40-hour training completed over 5–180 days, a competency assessment within 90 days of applying, and both a criminal background check and an abuse-registry check passed within 180 days of application payment. [9][10][11][12][13][14]

The state layer is a five-part enrollment screening package. Under the same April 2020 policy, every individually enrolling CCTS and IIS applicant must demonstrate a clean background across checks of Kansas Bureau of Investigation (KBI) records, the Adult Protective Services and Child Protective Services registries, the Nurse Aide Registry, and a motor-vehicle screen — that last one is a Kansas oddity, so collect driving records at onboarding. The bulletins don't publish a re-check cadence, and the KMAP HCBS Autism manual (which reportedly also requires proof of background checks and insurance at enrollment) sits on a portal we couldn't reach during research — confirm current screening details with KMAP provider enrollment directly. Layer federal exclusion screening on top regardless: check every hire against the HHS-OIG LEIE (and SAM.gov) at hire and monthly, since employing an excluded individual draws civil monetary penalties. [9][10][11][12][13][14]

At the supervisor tier, licensure has been mandatory since July 1, 2016: practicing ABA in Kansas requires a Licensed Behavior Analyst — or a Licensed Assistant Behavior Analyst under LBA supervision — through the Behavioral Sciences Regulatory Board under K.S.A. 65-7501 et seq. CCTS enrollment (type 11, specialty 403) takes a BSRB-licensed BCBA, BCBA-D, or BCaBA, or — another Kansas-specific alternative — a master's-level professional with documented ASD experience, state-approved training, and a KDADS letter. IIS technicians must work under the direction of a BCBA or qualified CCTS practitioner, but no Kansas-specific observation percentage or tech-per-supervisor ratio appears in any accessible primary source — for RBT-certified staff, the BACB's 5%-of-hours monthly supervision minimum (two face-to-face contacts per month, one individual, one observing service delivery) is the operative floor. The BSRB's own site was unreachable during our research, so confirm renewal and CE specifics with the board. Plan-level, Optum/UHC adds the real extras: KanCare ABA providers must hold a KMAP ID, carry $1M-per-occurrence / $1M-aggregate professional liability coverage, and contract separately with Optum's Kansas ABA network — and KMAP itself warns that MCO implementation dates can lag state policy, so verify each MCO's rollout individually. The MCO documents we reviewed add no staff-level background checks beyond the state baseline. [9][10][11][12][13][14]

## Intake gates

The questions that decide whether a family can start with KanCare (Kansas Medicaid), and what they have to bring.

- **Age limit**: Age 20 and under. CCTS and IIS moved out of the Autism waiver into the State Plan effective January 1, 2017 "under the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) provisions"; Bulletin 20147 describes them as covered "under the State Plan Services for EPSDT participants and Title XXI members"; and Bulletin 26140 fixes the diagnostician rule for "individuals aged 20 years and younger." Optum's Kansas Medicaid criteria state the bound outright: "the member is age 20 and under." [1][9][2]
- **Diagnosis recency**: Two rules now point in opposite directions, and the newer one is the state's. KMAP Bulletin 26140 — reissued 8/31/2026 with its effective date moved from September 1 to November 1, 2026 — states that once an individual is diagnosed by a qualified diagnostician under that policy, "they are eligible for autism treatment, including applied behavioral analysis (ABA) therapy, without the need for a re-evaluation of their autism spectrum disorder diagnosis. There is also no time limit on how soon they begin autism treatment... following their diagnosis of autism spectrum disorder." Optum's current State Mandates supplement (July 2026) carries that language verbatim for Kansas Medicaid members and no longer states a 6-month validation rule; Sunflower's KS.CP.01, last reviewed 06/2019, still requires that an "MD or licensed psychologist has evaluated w/in last 6 months for current validation of Autism diagnosis." Members already in treatment who were diagnosed by a non-qualifying diagnostician have two years to obtain an updated diagnosis, which "does not necessarily need to involve a complete diagnostic evaluation." [2][16][17]
- **Who may diagnose**: Since KMAP Bulletin 26140, for members age 20 and younger the ASD diagnosis must come from a Kansas Behavioral Sciences Regulatory Board (BSRB) licensed clinical psychologist or a qualified physician, with a multidisciplinary approach preferred. The bulletin lists the qualifying provider type/specialty codes: 11/112 Psychologist, 31/316 Family Practitioner, 31/318 General Practitioner, 31/326 Neurologist, 31/339 Psychiatrist, 31/345 General Pediatrician (Developmental), 31/349 Exempt License Physician and 31/351 Indian Health Services. A qualifying BSRB clinical psychologist needs a doctoral degree in psychology or equivalent training plus two years of supervised experience delivering BSRB-approved psychological services; qualifying physicians — developmental/behavioral pediatricians, psychiatrists, neurologists and primary care physicians — need documented additional training in ASD diagnosis, which Optum notes "may be subject to periodic audit/inquiry." [2][17]
- **Diagnostic tools required**: The diagnostic evaluation must document DSM criteria and symptom severity level and must rest on "a validated ASD diagnostic assessment tool such as the Autism Diagnostic Observation Schedule (ADOS) or the Childhood Autism Rating Scale (CARS)." Screening tools — M-CHAT, ABC, ASSQ, RITA-T, STAT — "have clinical value in recognizing children at risk of having ASD, but the diagnosis of ASD must rest on validated diagnostic tools such as those listed above." Recommended additions: a cognitive evaluation using CAT/CLAMS, MSEL or Bayley (a school district's validated cognitive testing may be used), and an adaptive measure such as ABAS or Vineland. [2][17]
- **Referral required?**: Required at the state level: "coverage requires that a recommendation be made by a physician or other licensed practitioner and is subject to a prior authorization (PA) process." MCOs add to it — Sunflower requires a "doctor recommendation of services/prescription/order to treat" inside the Autism Authorization Request packet, plus a current Kan Be Healthy (EPSDT) screen completed within the past year by a physician, APRN, PA or credentialed RN, which the policy is explicit is not the same thing as a well-child exam. [1][16]
- **Prior-auth decision time**: KanCare authorizes ABA (CCTS/IIS) only through the member's MCO, so the managed-care clock governs. Federal law caps a standard decision at 7 calendar days after the MCO receives the request, for rating periods starting on or after January 1, 2026. KanCare's rating periods run by calendar year, so the 7 days apply now; before 2026 the cap was 14. The MCO may extend by up to 14 more calendar days if the provider or family asks, or if it justifies needing more information. An expedited decision is due "no later than 72 hours after receipt of the request for service" when the standard clock could seriously jeopardize the child's health or ability to attain, maintain or regain maximum function. Sunflower and Healthy Blue print 7 days and 72 hours in their 2026 manuals. UnitedHealthcare's 2026 KanCare manual still prints a 14-day standard. Reauthorization runs at least every 6 months. How far ahead to file it is set by each MCO, not the state: Sunflower says request "at least five days prior" to service, and Healthy Blue accepts recertification requests up to 60 calendar days before expiry. [18][19][20][21][22]
  - Ask the plan: The member's MCO for the reauthorization lead time it applies to ABA. The KMAP fee-for-service manuals on portal.kmap-state-ks.us could not be opened.
- **Other insurance (who pays first)**: KanCare pays last. Any other coverage the child has (a parent's employer or marketplace plan, TRICARE, CHAMPVA) is billed first. Only the balance goes to the MCO, with the primary payer's EOB or remittance codes. Under 42 CFR 433.139(b), when other coverage is on file the claim is rejected back to the provider "for a determination of the amount of liability." The pay-and-chase exception covers preventive pediatric care: Healthy Blue names "preventive pediatric care, including KAN Be Healthy" and prenatal care, and Sunflower names "preventive and prenatal services." Treat ABA as bill-the-primary-first. TRICARE pays before Medicaid, because federal rules exclude Medicaid from TRICARE's double-coverage plans. Sunflower and Healthy Blue both deny the Medicaid balance when the primary denied for an administrative reason (no authorization, untimely filing), so follow the commercial plan's PA and network rules exactly. Sunflower spells out the practical step: if the primary denies ABA as non-covered or benefits exhausted, a Sunflower authorization is required, and it "encourage[s]" getting one up front for those denials. [23][24][20][21][22]
  - Ask the plan: The KMAP General TPL Payment Provider Manual (portal.kmap-state-ks.us, unreachable) for state-level TPL billing detail.

## Delivery and billing rules

Coverage decides whether KanCare (Kansas Medicaid) pays. These decide whether the claim survives: staffing and supervision, concurrent billing, per-day ceilings, who signs the note, where the service is payable, and whose NPI the claim goes out under.

- **Supervision**: Direction, not a ratio. IIS technicians (provider type 11, specialty 404) qualify either by "certification as a Registered Behavior Technician (RBT) under the supervision of a BCBA" or through the state-equivalent pathway — 18 or older, high-school diploma, 40 hours of ABA training including 8 hours of supervised intervention work and 3 hours of ethics plus at least one hour each of criterion reference, social skills training, parent training and program development, an initial competency assessment, and an acceptance letter signed by the KDADS HCBS Autism Waiver Program Manager or HCBS Director. Either way "this provider works under the direction of the BCBA or other Qualified CCTS Practitioner" and must "meet all annual training requirements as specified by certification." No Kansas observation percentage or technician-per-supervisor ratio appears in any accessible primary source, so the BACB's 5%-of-monthly-hours floor is the operative number for RBT-credentialed staff. [9][10]
- **Daily limits / MUEs**: Kansas publishes annual and weekly soft limits, not per-day ceilings. "The approved State Plan soft limits for the Consultative Clinical and Therapeutic Services (CCTS) remain in effect at an annual amount of 50 hours. The approved State Plan soft limits for Intensive Individual Supports (IIS) also remain in effect with an initial authorization of up to 25 hours per week. For these services, additional hours can be authorized based on a demonstration that the medical necessity criteria are being met." On top of that, Optum's Kansas Medicaid criteria cap the individualized treatment plan at "no more than 40 hours per week." [4][17]
- **Bill as provider**: Every individual bills under their own NPI, and every individual needs their own KMAP ID first. The group and the individual health care professionals "must be enrolled with KMAP and must have a KMAP ID to bill for Medicaid services. Your group must be enrolled and have a KMAP ID before your individual ABAs or RBTs can enroll," and "when you hire new ABAs or RBTs, you must enroll them through KMAP before you can bill Medicaid under the employee's NPI number." KMAP also requires a separate enrollment for each location from which services will be rendered. CCTS enrolls as provider type 11, specialty 403; IIS as 11/404. [6][10]
- **Concurrent billing (97153 + 97155):** Not published / unverified. Verify via: The KMAP Mental Health Fee-for-Service Provider Manual (portal.kmap-state-ks.us was unreachable at this review), and each MCO — Sunflower, Optum and Healthy Blue run their own claim editing. [9][6]

## What intake should collect for KanCare (Kansas Medicaid)

- **KanCare MCO:** Sunflower, UnitedHealthcare, or Healthy Blue — same CCTS/IIS baseline, different PA machinery. Anything saying "Aetna Better Health" is stale (moved to Healthy Blue 1/1/2025).
- **ASD diagnosis + date:** Diagnosing MD/psychologist, credentials, and the evaluation date — Sunflower and Optum require validation within the last 6 months, so an old report may need a refresh first.
- **Physician/practitioner recommendation:** The CCTS PA requires a recommendation by a physician or other licensed practitioner — chase it at intake.
- **Kan Be Healthy screen status:** Sunflower members need a current EPSDT screen within the past year (not the same as a well-child exam) — a silent auth-staller.
- **KMAP enrollment of rendering staff:** Each BCBA and each RBT needs their own KMAP ID (per service location) before any MCO can pay — confirm before quoting start dates.

Free verification-call checklist (PDF): https://carelu.com/downloads/aba-verification-call-checklist.pdf

## Verification of benefits (VOB) data

How KanCare (Kansas Medicaid) ABA benefits route and read on an eligibility check. Data last updated 2026-07-23.

### EDI routing

- **Payer ID (pVerify):** 00128 — pVerify's own table flags "00128 Kansas Medicaid" as Eligibility=Yes / Claim=No — eligibility checks are supported, claim-status checks are not, per pVerify's own table.
- **Supports 270/271 eligibility:** Yes
- **Real-time eligibility:** Yes
- **Behavioral health administrator:** none — No KMAP source states or disclaims a BH carve-out for ABA specifically — inferred "none" from every reviewed MCO guide describing CCTS/IIS as billed directly (contrast with unitedhealthcare-community-plan-kansas below, which DOES route ABA through Optum). Per docs/vob-gaps.md census: "ABA is MCO-administered... no statewide carve-out."
- **ABA rides on:** medical benefit
- **Two-hop verification required:** No
- **Where the 271 carries MCO enrollment:** Loop 2110C, 12th Repetition (Managed Care): EB (Subscriber Eligibility/Benefit Information) segment, EB03 (Service Type Code) = 30, which KMAP interprets as "Managed care organization"; EB05 = Plan Coverage Description (free-text MCO name). A related but distinct repetition uses EB03 values 1/35/56/MH for "Primary care provider."

### Code-level coverage

| Code | Covered | Prior auth | Unit cap | Place of service | Telehealth | Modifiers |
| --- | --- | --- | --- | --- | --- | --- |
| 97151 | Yes | Required — physician/licensed-practitioner recommendation + prior authorization, per MCO intake (KMAP Bulletin 17129) | Service-level, not per-code: CCTS soft limit 50 hrs/year; IIS initial authorization up to 25 hrs/week (more available on medical necessity). Billed under CCTS. per CCTS: year (soft limit); IIS: week (initial authorization) | — | — | — |
| 97152 | Yes | Required — physician/licensed-practitioner recommendation + prior authorization, per MCO intake (KMAP Bulletin 17129) | Service-level, not per-code: CCTS soft limit 50 hrs/year; IIS initial authorization up to 25 hrs/week (more available on medical necessity). Billed under CCTS. per CCTS: year (soft limit); IIS: week (initial authorization) | — | — | — |
| 97153 | Yes | Required — physician/licensed-practitioner recommendation + prior authorization, per MCO intake (KMAP Bulletin 17129) | Service-level, not per-code: CCTS soft limit 50 hrs/year; IIS initial authorization up to 25 hrs/week (more available on medical necessity). Billed under CCTS or IIS. per CCTS: year (soft limit); IIS: week (initial authorization) | — | — | — |
| 97154 | Yes | Required — physician/licensed-practitioner recommendation + prior authorization, per MCO intake (KMAP Bulletin 17129) | Service-level, not per-code: CCTS soft limit 50 hrs/year; IIS initial authorization up to 25 hrs/week (more available on medical necessity). Billed under CCTS or IIS. per CCTS: year (soft limit); IIS: week (initial authorization) | — | — | — |
| 97155 | Yes | Required — physician/licensed-practitioner recommendation + prior authorization, per MCO intake (KMAP Bulletin 17129) | Service-level, not per-code: CCTS soft limit 50 hrs/year; IIS initial authorization up to 25 hrs/week (more available on medical necessity). Billed under CCTS. per CCTS: year (soft limit); IIS: week (initial authorization) | — | — | — |
| 97156 | Yes | Required — physician/licensed-practitioner recommendation + prior authorization, per MCO intake (KMAP Bulletin 17129) | Service-level, not per-code: CCTS soft limit 50 hrs/year; IIS initial authorization up to 25 hrs/week (more available on medical necessity). Billed under CCTS. per CCTS: year (soft limit); IIS: week (initial authorization) | — | — | — |
| 97158 | Yes | Required — physician/licensed-practitioner recommendation + prior authorization, per MCO intake (KMAP Bulletin 17129) | Service-level, not per-code: CCTS soft limit 50 hrs/year; IIS initial authorization up to 25 hrs/week (more available on medical necessity). Billed under CCTS. per CCTS: year (soft limit); IIS: week (initial authorization) | — | — | — |

Code notes:

- **97151:** Comprehensive assessment, now billed under CCTS. Billable under this service since the 1/1/2017 State Plan CCTS/IIS transition.
- **97152, 97155, 97156:** Billable under this service since the 1/1/2017 State Plan CCTS/IIS transition.
- **97153:** Originally IIS-only (technician-delivered 1:1); CCTS was also authorized to bill this code effective 7/1/2024. Billable under this service effective 7/1/2024 — a later addition to the original 1/1/2017 CCTS/IIS code set.
- **97154, 97158:** Billable under this service effective 7/1/2024 — a later addition to the original 1/1/2017 CCTS/IIS code set.

### Medicaid rates

Source: KMAP interactive fee-schedule lookup is the stated source of truth but is not machine-accessible (SSO wall). Last dated anchor: KMAP Bulletin 18259 set 97151 at $17.50/15-min unit effective 1/1/2019; KMAP Bulletin 19029 raised rates effective 4/1/2019 without publishing amounts; the 7/1/2022 BH increase (Bulletin 22128) explicitly excluded 9715x codes; the FY2024/2025/2026 HCBS rate bulletins (checked this pass) cover only BI/TA/I-DD HCBS waiver services and the separate HCBS Autism waiver code T2040, not State Plan CCTS/IIS. Every code below except 97151 is unverified. Effective 2019-01-01.

| Code | Rate | Unit | Modifier tiers |
| --- | --- | --- | --- |
| 97151 | $17.50 (stale 2019 anchor — raised 4/1/2019 by an unpublished amount; current figure unverified) | 15min | — |

### Contacts

- **Provider services phone:** 1-800-933-6593, option 8
- **Phone menu path:** Option 8 = KMAP Provider Service Number (recipient eligibility, claim status, billing/payment, secure-website questions, including Direct Data Entry claims). Option 4 routes to EDI Customer Service instead — use that only for trading-partner/270-271 connectivity issues, not benefit questions.
- **Hours:** Real-time 270/271 responses average under 2 seconds 90% of the time between 7:00 a.m. and 7:00 p.m. Central Time, 7 days/week, per the companion guide’s system-availability note — not confirmed to be identical to Customer Service phone hours.
- **Portal:** [KMAP secure website](https://portal.kmap-state-ks.us)

Questions to ask on a verification call:

- What is the current per-unit reimbursement rate for 97152, 97153, 97154, 97155, 97156, and 97158 under the State Plan CCTS/IIS benefit?
- What POS codes and telehealth modifiers are accepted for CCTS/IIS billing?
- Is there a numeric MCO carrier-code table for the 271 response, or is MCO enrollment still identified by a free-text plan description only?
- What eligibility-span granularity does a live 271 return — monthly, daily, or real-time?
- Does KMAP pay ABA claims directly, or is there a behavioral-health carve-out administrator for autism services specifically?

### VOB data sources

- https://www.kmap-state-ks.us/Documents/EDI/2017-05_270-271-DXC.pdf (accessed 2026-07-23; source document older than 18 months)
- https://pverify.com/wp-content/uploads/2026/03/pVerifyPayers_All-Payers-List-3-2026.pdf (accessed 2026-07-23)
- https://essentials.availity.com/availity/documents/payer_list_wShortNames.pdf (accessed 2026-07-23; source document older than 18 months)
- https://www.sunflowerhealthplan.com/newsroom/kmap-17129.html (accessed 2026-07-23)
- https://www.sunflowerhealthplan.com/newsroom/kmap-19029.html (accessed 2026-07-23)
- https://www.sunflowerhealthplan.com/newsroom/kmap-18259.html (accessed 2026-07-23)
- https://www.sunflowerhealthplan.com/newsroom/kmap-221280.html (accessed 2026-07-23)
- https://www.sunflowerhealthplan.com/newsroom/kmap-24116.html (accessed 2026-07-23)
- https://www.sunflowerhealthplan.com/newsroom/kmap-25122.html (accessed 2026-07-23)
- https://portal.kmap-state-ks.us/PublicPage/ProviderPricing/FeeSchedules (accessed 2026-07-23; source document older than 18 months)

## Common questions

### Does KanCare (Kansas Medicaid) cover ABA therapy?

Yes — but Kansas doesn't label it ABA. It's covered under EPSDT for members age 20 and under as two services: CCTS (the BCBA tier, soft limit 50 hours/year) and IIS (the technician 1:1 tier, initially authorized up to 25 hours/week, more on medical necessity), with prior authorization through the member's MCO.

### Which MCOs run KanCare autism services?

Sunflower Health Plan, UnitedHealthcare Community Plan (Optum behavioral health), and Healthy Blue Kansas — the new plan effective 1/1/2025. Aetna Better Health of Kansas lost its contract; its members moved to Healthy Blue on 1/1/2025.

### How recent does the autism diagnosis need to be?

Both Sunflower and Optum/UHC require the ASD diagnosis to have been validated by an MD or licensed psychologist within the last 6 months at initial authorization — plan for a diagnostic refresh if the report is older.

### Who is allowed to make the ASD diagnosis for KanCare members?

As of KMAP Bulletin 26140 (eff. 11/1/2026), for members age 20 and under the diagnosis must come from a Kansas BSRB-licensed clinical psychologist or a qualified physician, documented against DSM criteria/severity using a validated tool such as ADOS or CARS. This layers on top of the existing 6-month diagnosis-currency rule rather than replacing it; existing members diagnosed by a non-compliant provider get a 2-year grace period.

### What does Kansas Medicaid pay for ABA?

Current rates aren't reliably published. The last public anchor is $17.50/15-minute unit for 97151 effective 1/1/2019, raised 4/1/2019 without published amounts; the 2022 BH increase skipped the 9715x codes. Pull current figures from the KMAP interactive fee-schedule lookup — the only source of truth.

## Primary sources

1. [KMAP Bulletin 17129 — Additional State Plan Services (CCTS/IIS, eff. 1/1/2017)](https://www.sunflowerhealthplan.com/newsroom/kmap-17129.html)
2. [KMAP Bulletin 26140 — ASD diagnosis credential requirement (issued 8/12/2026; reissued 8/31/2026, eff. 11/1/2026)](https://www.sunflowerhealthplan.com/newsroom/kmap-26140.html)
3. [KMAP Bulletin 18259 — Mental Health/Autism CPT crosswalk (eff. 1/1/2019)](https://www.sunflowerhealthplan.com/newsroom/kmap-18259.html)
4. [KMAP Bulletin 19029 — Rate Increase for Autism Services (eff. 4/1/2019)](https://www.sunflowerhealthplan.com/newsroom/kmap-19029.html)
5. [KMAP Bulletin 22128 — BH Services Rate Increase 7/1/2022](https://www.sunflowerhealthplan.com/newsroom/kmap-221280.html)
6. [UHC/Optum — KanCare ASD getting-started guide (BH00567_10102024)](https://public.providerexpress.com/content/dam/ope-provexpr/us/pdfs/clinResourcesMain/autismABA/ksABA/ksHowToAuth.pdf)
7. [KDHE — KanCare MCO contract awards 2025–2027](https://www.kdhe.ks.gov/CivicAlerts.aspx?AID=1104)
8. [KMAP fee schedules — interactive lookup (source of truth for current rates)](https://portal.kmap-state-ks.us/PublicPage/ProviderPricing/FeeSchedules)
9. [KMAP Bulletin 20147 — Autism CCTS & IIS provider qualification changes (eff. 4/3/2020)](https://www.sunflowerhealthplan.com/newsroom/kmap-20147.html)
10. [KMAP Bulletin 21013 — CCTS/IIS provider enrollment clarification](https://www.sunflowerhealthplan.com/newsroom/kmap-21013.html)
11. [K.S.A. 65-7503 — behavior analyst licensure required; exemptions](https://www.ksrevisor.gov/statutes/chapters/ch65/065_075_0003.html)
12. [BACB RBT Handbook (updated 06/2026)](https://www.bacb.com/rbt-handbook)
13. [HHS-OIG Exclusions Program (LEIE)](https://oig.hhs.gov/exclusions/)
14. [Optum/UHC — KanCare Autism/ABA Program provider training (BH00698_10292024)](https://public.providerexpress.com/content/dam/ope-provexpr/us/pdfs/clinResourcesMain/autismABA/ksABA/ks-abaTraining.pdf)
15. [Kansas Action for Children — State selects companies to manage KanCare (Aetna → Healthy Blue transition)](https://www.kac.org/state_selects_companies_to_manage_kancare)
16. [Sunflower KS.CP.01 — Applied Behavioral Analysis (clinical policy)](https://www.sunflowerhealthplan.com/content/dam/centene/sunflower/policies/clinical-policies/KS.CP.01-Applied-Behavioral-Analysis.pdf)
17. [Optum — ABA State Mandates supplemental criteria (Kansas Medicaid section)](https://public.providerexpress.com/content/dam/ope-provexpr/us/pdfs/clinResourcesMain/guidelines/scc/ABA_SCC_SM.pdf)
18. [42 CFR 438.210(d) — MCO authorization timeframes (eCFR)](https://www.ecfr.gov/current/title-42/section-438.210)
19. [KanCare 3.0 cost proposal, RFP EVT0009267 (calendar-year rating period)](https://admin.ks.gov/media/cms/Healthy_Blue_KanCare_Cost_CCHPKS_add1b632ef81a.pdf)
20. [Sunflower Health Plan Provider Manual (KDHE-approved Feb 27, 2026)](https://www.sunflowerhealthplan.com/content/dam/centene/sunflower/pdfs/Sunflower_ProviderManual.pdf)
21. [Healthy Blue Kansas Medicaid Provider Manual (June 2026)](https://www.healthybluekansas.com/content/dam/digital/healthyblue/documents/provider/ks/general/KSHB-CD-PM-061368-24-EXPRESS-KanCare.pdf)
22. [UnitedHealthcare Community Plan KanCare Care Provider Manual (2026)](https://www.uhcprovider.com/content/dam/provider/docs/public/admin-guides/comm-plan/KS-AdminGuide.pdf)
23. [42 CFR 433.139 — Medicaid third-party liability (eCFR)](https://www.ecfr.gov/current/title-42/section-433.139)
24. [32 CFR 199.8 — TRICARE double coverage (Medicaid excepted)](https://www.ecfr.gov/current/title-32/section-199.8)

Payer policies change frequently and vary by plan, state, and funding type. This guide was compiled from the sources above and last reviewed September 2026; it is general information, not billing, legal, or clinical advice. Always verify current requirements against the payer's live policy and a benefits check for the specific member.

Source: Carelu ABA Payer Directory — https://carelu.com/payers. Free to cite with attribution.