KMAP BULLETIN: Rate Increase for Autism Services

Date: 03/06/19

KMAP GENERAL BULLETIN 19029 (PDF)

Effective with dates of service on and after April 1, 2019, rate increases will be made for autism-related State Plan services codes 97155, 97153, 97151, 97152, and 97153.

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.

To view the most current rates, providers can access the KMAP Reference Codes page of the KMAP website. This is an interactive page for numerous searches. The Search by Procedure link allows providers to enter the HCPCS code along with the date of service (DOS).

Note: The effective date of the policy is April 1, 2019.

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.