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KMAP BULLETIN: HCBS Brain Injury Waiver – Cognitive Therapy Billing Changes

Date: 03/31/26

KMAP GENERAL BULLETIN 26053 (PDF)

Effective dates of service on or after May 1, 2026, Cognitive Therapy services delivered under the HCBS Brain Injury (BI) waiver shall be billed exclusively using procedure code 97129.

Cognitive Therapy services previously billed using codes 97535 and 97537 shall no longer be used for BI Waiver Cognitive Therapy claims for dates of service on or after this effective date.

  • Code: 97129
  • Rate: $25.00 per 15-minute unit

Billing Guidance:

CPT code 97129 shall represent the full duration of the Cognitive Therapy encounter, consistent with the participant’s  Person-Centered Service Plan (PCSP) and applicable waiver service limits, including the annual 3,120-unit cap across rehabilitation therapy services.

NCCI Edit Configuration:

The National Correct Coding Initiative (NCCI) Medically Unlikely Edit (MUE) Practitioner (PRA) edits for CPT code 97129 shall be deactivated for Brain Injury Waiver members only.

Electronic Visit Verification (EVV):

EVV remains required for all BI Waiver Cognitive Therapy services billed under CPT code 97129. Providers must ensure that EVV records accurately reflect service delivery consistent with waiver requirements.

Approved Place of Service Codes:

The following Place of Service (POS) codes may be used when billing CPT code 97129 for BI Cognitive Therapy services: 

Covered POS Code

  • 02 - Telehealth
  • 03 - School
  • 04 - Homeless Shelter
  • 10 - Telehealth (in home)
  • 11 - Office
  • 12 - Home
  • 13 - Assisted Living Facility
  • 16 - Temporary Lodging
  • 18 - Place of Employment
  • 53 - Community Mental Health Center
  • 99 - Other Place of Service

Note: The effective date of the policy is May 1, 2026. 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. 

For changes resulting from this bulletin, view the updated HCBS BI  Fee-for-Service Provider Manual, pages 7-2, 8-1 to 8-2, and 8-19.