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KMAP BULLETIN: UPDATED - Crisis Intervention Services Coverage

Date: 02/24/25

*Updates indicated by bold italics*

KMAP GENERAL BULLETIN 24204 (PDF)

UPDATED - Effective with dates of service on and after October 1, 2024, the Crisis Intervention (CI) Service is a face-to-face intervention provided based on the diagnostic assessment of risk, mental status, and medical stability, as determined by a Licensed Mental Health Practitioner (LMHP) with experience regarding this specialized behavioral health service.

A new singular service code, S9484U1, is defined for CI Services, with a reimbursement rate of $88.48 per hour (one unit). When billing for CI Services for less than the per unit (hour), follow procedures described in the Specific Billing Instructions section of the Kansas Medical Assistance Program (KMAP) Mental Health Fee-for-Service Provider Manual.

Billing Guidelines – Time of Service:

Claims submitted for CI services shall meet the following requirements:

  • Claims shall meet the midpoint time requirements of 51% or more (31 minutes) for 1 unit of service. No payment will be made for the CI services with less than 31 minutes.
  • Post one (1) full unit of service (60 minutes), the units claimed may be decremented to the next midpoint time requirement when met (91 minutes), at which time the time requirement is met for 2 units and so on for subsequent units of service.
  • For example:
Time of ServiceBillable Quantity
0-30 minutes0 units (no payment will be made)
31-60 minutes1 unit (as the first hour passed the midpoint)
61-75 minutes1.25 units
76-90 minutes1.50 units
91-120 minutes2 units (as the second hour passed the midpoint)
121-135 minutes2.25 units
135-150 minutes2.50 units
151-180 minutes3 units 1 unit (as the third hour passed the midpoint)

*Prior to the equivalent of the time of service equaling 1 unit (31 minutes), do not claim or bill for .25, .50, or .75 units.

Note: Please review your claim to ensure the units of service entered on your claim are not the minutes of service delivery.

Billing Guidelines - Third Party Liability (TPL):
Other insurance carriers may reimburse for crisis intervention services. The code (S9484 U1) will not be added to the TPL bypass list, providers should follow the guidance in the KMAP General TPL Payment Provider Manual, as Medicaid is the payor of last resort.
*CCBHCs can utilize pay and chase.

When billing for CI Services, follow provider level guidance procedures described in the Crisis Intervention section of the Kansas Medical Assistance Program (KMAP) Mental Health Fee-for-Service Provider Manual. 

The coverage and reimbursement for the following three tiers of CI codes will be discontinued: 

Crisis Intervention TierDiscontinuted CodeReplacement Code, Effective October 1, 2024
Basic CIH2011S9484 U1
Intermediate CIH2011 HOS9484 U1
Advanced CIH2011 HKS9484 U1

CI Services are designed to interrupt and/or alleviate a crisis experience by reducing symptoms, stabilizing, and restoring to a  previous level of functioning. 

Service Criteria:

  • CI Services shall be available 24 hours a day for 365 days.
  • The assessment shall include the medical necessity of the services  determined by a licensed mental health practitioner or physician  conducting an assessment consistent with state law, regulation, and policy.
  • Re-evaluation for the need for CI Services, which includes crisis stabilization, is to be completed by an LMHP every 72 hours or more frequently as needed. 
  • The LMHP shall include the amount of time spent (start and stop) in the documentation if not captured in the Electronic Health Record (EHR).

A crisis plan, developed from the diagnostic assessment by an LMHP, serves to facilitate immediate crisis resolution and de-escalation. It includes flexible services to assist in stabilizing the individual in their community setting and involves contact with the individual, family members, or other collateral contacts (e.g., caregiver, school personnel) to gather pertinent information for the purpose of the preliminary assessment and/or referral to other alternative mental health services at an appropriate level.

All activities must occur within the context of a potential or actual psychiatric crisis with the goals of diagnosis, symptom  reduction, stabilization, and restoration to a previous level of  functioning. Services may include a preliminary visual assessment to determine risk and ability to engage; immediate crisis resolution  and deescalation; referral and linkage to appropriate community services to avoid more restrictive or higher levels of care; and,  when necessary, triage to a higher level of care.

When an individual requires the assistance of another person to regulate behavior and/or stabilize, the services delivered to the individual by anyone other than an LMHP must be provided  under the supervision of an LMHP. In addition, an LMHP must  always be available to provide backup, support, and/or consultation to the supporting staff member who is not an LMHP and is  providing crisis stabilization services.


Limitations/Exclusions:

  • CI Services shall not be provided in an Institution of Mental Disease (IMD).
  • An LMHP must re-evaluate Upon re-evaluation of  the need for crisis stabilization services every 72 hours or more frequently as needed. Documentation shall the LMHP shall include the documentation specifying the needs to be addressed during a continuation of services and the specific services to be provided. Services should meet the requirements listed in the KMAP Mental Health Fee-for-Service Provider Manual for CI Services.
  • Note: In all instances, when two staff are providing Crisis Stabilization services, the total units of care should be listed for each service provider and not submitted as a combined total of units. Each provider of the CI Services should be listed, and the second provider service line should contain modifier 77 to indicate that the details are not duplicates.
  • For the safety of the individual and staff, applicable support serviced deemed medically necessary by the LMHP S9484 U1 may be billed by paraprofessional providers concurrently, not to exceed three hours (for a total of six hours) when the need is identified for the individual. Documentation should specify this need for safety reasons and be re-evaluated by a LMHP every 23 hours.

The following enrolled supervising Provider Type/Provider Specialties (PT/PS) will be allowed when billed as the rendering provider:

PT 09 - Advance Practice Nurse: 

PSDescription
 093 Nurse Practitioner (Other) 
 096 Psychiatric Nurse Practitioner 

 

PT 10 - Mid-Level Practitioner:

 PS  Description 
 100  Physician Assistant 

 

PT 11 - Mental Health Provider:

 PS  Description 
 108  Licensed Master’s Level Psychologist (LMLP)
 109  Licensed Clinical Psychotherapist (LCP)
 111  Community Mental Health Center (CMHC)
 112  Psychologist
 115 Licensed Mental Health Professional (LMHP)
 116  Licensed Clinical Mental Health Professional (LCMHP) 
 121  Certified Community Behavioral Health Clinic (CCBHC)
 123  Children with Severe Emotional Disturbances
 125  Home Based Family Therapy
 176  Alcohol and Drug Rehabilitation

 

PT 31 - Physician:

 PS  Description 
 316  Family Practitioner 
 318  General Practitioner 
 339  Psychiatrist
 348  Addiction Medicine
 349  Exempt License Physician 

 

Professional Providers in accordance with state law, shall be:

  1. Licensed in their appropriate discipline
  2. Enrolled in KMAP
  3. Review the Contract with KanCare MCO as applicable
  4. Complete training approved by the Kansas Department for Aging and Disability Services (KDADS) for CI.

Non-licensed and Paraprofessional providers shall be under the supervision of an LMHP and shall complete the required  training as directed:

    • Training approved by the KDADS for non-licensed mental health service providers can be found on the KDADS website:
      • Providers-Trainings-State Training Requirements
  2. Training shall be completed as directed in training requirements, and all training kept onsite by the supervising professional.

Note: The effective date of the policy is October 1, 2024. The implementation of State policy by the KanCare Managed  Care Organizations (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.