For an intake team in Kansas, an Aetna card means three layers at once: the carrier's national clinical policy, Kansas's autism insurance mandate (K.S.A. 40-2,194), and the plan's funding type deciding which of the two actually binds. This guide stacks them in order — plus one Kansas-specific correction worth making early: Aetna no longer runs a Medicaid plan in Kansas.
Aetna covers ABA for autism spectrum disorder under its national clinical policy CPB 0554 (paired with CPB 0648 for ASD), and considers ABA experimental for anything else. Precertification is required for both the assessment and treatment — form GR-69017-4, submitted via Availity or phone — with reauthorization commonly on a roughly 6-month cadence. That clinical policy is national — we found no Kansas-specific Aetna ABA policy, form, or supplement — so what changes in Kansas is the legal floor underneath it: the state mandate below governs what fully-insured large-group plans must cover, while self-funded employer plans answer to ERISA and federal parity instead. Plan funding type is therefore the first fact to establish on every benefits check. The full national policy breakdown lives in our Aetna guide; this page covers what changes in Kansas.[1][2][17][16][9]
Kansas's mandate, K.S.A. 40-2,194, is one of the narrower ones in our directory. It reaches large-group policies, service-corporation contracts, fraternal benefit societies, and HMOs (issued/renewed after 1/1/2015; grandfathered plans from 1/1/2016), and 2023's SB 24 redefined "large employer" down to 51+ employees. Coverage is limited to covered individuals under age 12, and ABA carries hour-based caps: 1,300 hours/year for 4 years for a child diagnosed between birth and age 5, otherwise 520 hours/year until age 12 — though plans may exceed the caps with prior approval when medically necessary, the statute's own escape valve. Day care, facility-based, and school-based services are excluded; after 7/1/2016 ABA under the mandate must be delivered by providers licensed or exempt under the ABA licensure act. Small employers (2–50) can obtain a waiver by showing a 2.5%+ premium increase, self-funded ERISA plans sit outside the statute entirely, and a member diagnosed under any DSM edition cannot be forced into re-evaluation upon DSM revision. Advocacy analysis (not a regulator determination) treats the under-12 age limit and hour caps as unenforceable quantitative limits under MHPAEA for parity-covered plans — so treat cap-based denials as appealable, not final.[4][5][8]
Unlike many states, "we have Aetna" in Kansas cannot mean Medicaid anymore: Aetna Better Health of Kansas served KanCare from 2019 to 2024, lost the KanCare 3.0 contract, and its members auto-transitioned to Healthy Blue Kansas on January 1, 2025. Any directory, card, or family memory pointing at Aetna Better Health of Kansas is stale — route those inquiries to the Healthy Blue Kansas guide (or Sunflower/UHC if the family actively switched). Every Aetna card you see in Kansas today is commercial.[7]
Kansas has required licensure for practicing behavior analysts since July 1, 2016: the Licensed Behavior Analyst (LBA) and Licensed Assistant Behavior Analyst (LaBA) credentials under the applied behavior analysis licensure act (K.S.A. 65-7501 et seq.), administered by the Behavioral Sciences Regulatory Board and keyed to BACB certification — and the mandate itself conditions ABA coverage on licensed or exempt providers, so licensure is a coverage requirement, not just a credentialing one. On rates: Aetna does not publish commercial ABA fee schedules for Kansas (none of the national carriers do) — rates are contract-negotiated and live in your participating-provider agreement. The usual Medicaid benchmark is also unusually opaque here: current KanCare autism-services rates are only available through the KMAP interactive fee-schedule lookup, so pull them there before a rate negotiation.[6]
Aetna's own rule is written from the practitioner's side, not the member's. Its provider manual says that for practitioners treating autism with ABA “either national certification is needed from the Behavior Analyst Certification Board (BACB), or the practitioner must be licensed as a behavior analyst in the state in which they practice,” that every provider “must be credentialed in order to initially participate in our network” (recredentialed every three years), and, for telehealth, that “Providers must act within the scope of their license and ensure that they have the proper licensure based on state requirements.” The ABA Medical Necessity Guide adds that services “must be provided directly or billed by licensed behavior analysts (in states with behavior analyst licensure laws), board-certified behavior analysts, or licensed psychologists.” Aetna publishes no rule that a BCBA based in another state is refused, and none that it is accepted, for a Kansas member.[14][9][3][10][18][19][11][12][13]
Aetna's Network Participation Criteria (form 8100606-01-01, 5/26) settle the telehealth half from Aetna's side. Its Telehealth criteria bind every "Hybrid Provider" and "Virtual Only Provider": "Providers must satisfy all applicable license, registration, and certification requirements noted in the participation criteria for all states in which members to whom they are providing Telehealth services are located. As required by applicable law, providers must also hold licenses, registrations, and certifications in the state(s) in which they are physically located." For a child located in Kansas, that points to Kansas's requirements as well as the BCBA's home state. The ABA section adds that "All BCBAs, BCaBAs and paraprofessionals must meet state requirements," that BCBAs "must meet the current Aetna® credentialing and recredentialing standards," and that only telehealth codes listed in Aetna's Telemedicine and Direct Patient Contact Payment Policy are payable unless law requires otherwise. A Virtual Only Provider need not keep a physical office but must have referral arrangements with participating providers for in-person care.[14][9][3][10][18][19][11][12][13]
Kansas law is what makes the Kansas license the practical requirement. K.S.A. 65-7503: “On or after July 1, 2016, no person shall practice applied behavior analysis in this state unless they are” a licensed behavior analyst, a LaBA under LBA supervision, a supervised trainee, or a licensed psychologist. On a fully insured large-group Kansas plan the mandate ties payment to the same act: “reimbursement shall be allowed only for services provided by an autism service provider licensed or exempt from licensure under the applied behavior analysis licensure act” (K.S.A. 40-2,194). The Kansas telemedicine act's coverage-parity rule (K.S.A. 40-2,213) protects services delivered “by a healthcare provider,” which it defines to include a “person licensed, registered, certified or otherwise authorized to practice by the behavioral sciences regulatory board” — a BCBA holding only another state's license is not in that definition. Neither the statute nor the BSRB's behavior-analyst regulations (K.A.R. 102-8) says in terms whether a BCBA outside Kansas treating a child located in Kansas by video is “practicing in this state,” so the safe plan is a Kansas LBA before the first remote session. Getting one: the BSRB application asks whether you “intend to apply under the provisions of 2021 House Bill 2066” (K.S.A. 48-3406), the expedited route for a holder of another state's license who has established or intends to establish Kansas residency — a license due within 45 days of a complete application (issued on up-to-six-months' probation when no Kansas endorsement route fits). A BCBA who neither lives in nor intends to move to Kansas applies on the ordinary LBA application.[14][9][3][10][18][19][11][12][13]
Aetna publishes no ABA rate table. Its provider manual (6/26) treats payment as a contract term: “The rates and compensation under your agreement are subject to the Aetna coding/claim edit policies,” and where a provider has both an intermediary contract and a direct agreement, “your direct Aetna rates will apply unless we specifically notify you otherwise.” Even when a member’s benefits run out, the provider “cannot charge them more than the contracted rate.” Get the rates from your Aetna agreement or Aetna provider services. For a public benchmark, KanCare pays 97153 at $16.25 per 15 minutes since 7/1/2024 (KMAP Bulletin 24125); the other autism codes are in the KMAP fee-schedule lookup.[14][15]
On fully insured Kansas coverage, the prompt payment act gives the insurer 30 days from receipt to "pay a clean claim for reimbursement" or send a written or electronic notice that it is denying all or part of the claim (with each reason) or needs specific additional information. Interest runs "at the rate of 1% per month" on any amount still unpaid 30 days after receipt, and is added without a separate claim. Once the provider supplies the requested information (due within 30 days of the request), the insurer has 15 days to pay or deny, again at 1% a month if it does not. The act exempts good-faith disputes and suspected fraud, and it binds insurers issuing accident and sickness policies, so a self-funded employer plan administered by Aetna follows its plan document instead (K.S.A. 40-2442).[20]
Aetna publishes no ABA-specific referring-provider rule. Its provider manual defines a clean claim as including "A corresponding referral (whether in paper or electronic format), if required for the applicable claim" plus all CMS-1500 data elements, and it treats behavioral health as direct access: members "may access behavioral health care" "Through direct access to the behavioral health provider," through a PCP recommendation, or through an EAP referral. PCP referrals are a feature of plans "that require the issuance of referrals for specialist care," and even there they apply "other than for direct-access services."[14]
So box 17 is not a published condition of an Aetna ABA claim in Kansas. If a plan design does require a referral, the eligibility-and-benefits response shows it; enter the referring provider only when one exists.[14]
Aetna publishes no rule on ABA delivered at the same clock time as speech, OT or PT. What it asks for is coordination. Precertification form GR-69017-4 (7-26) asks whether the member gets physical, occupational or speech therapy, mental health services or school services, and "Do you collaborate with all the providers above?" (if not, explain why). The Medical Necessity Guide expects "ongoing collaboration and coordination with existing providers and/or the school district."[16][9]
Report the other therapies and their schedule on the precertification request, and ask Aetna's precertification line before billing ABA minutes that overlap another therapy.[16][9]
Start on Availity with the Authorization (Precertification) Add transaction, or call the precertification department. Form GR-69017-4 (7-26) is not used to start a request. It supplies the clinicals when a case pends, attached on Availity or faxed to FaxHub 833-596-0339. Since August 1, 2026 it "replaces all other Applied Behavior Health Analysis (ABA) precertification information request documents and forms" (not for Maryland or Massachusetts plans).[16]
For the assessment, request 97151, 97152 and 0362T in hours per authorization period. Treatment codes are requested in hours per week. The form also asks for the current DSM-5 diagnosis codes, the "Diagnosing Provider (name and credentials)," who will supervise, whether any hours fall during class, and the child's other services (PT, OT, speech, mental health, PCP, school). Supporting documents, "where applicable," include a standardized assessment (Vineland, ABAS, VB-MAPP) "completed within the past 12 months," the treatment plan with baseline data, caregiver goals, and titration and discharge criteria. Questions: 1-800-424-4047.[16]
Aetna does not publish one. Its national provider manual (edition 6/26) defines a clean claim as one “received in a timely manner” with all the CMS-1500 data elements, but gives no day count, so the filing window is the one in your Aetna participation agreement. Kansas law does not supply a default either: the prompt payment act (K.S.A. 40-2442) sets the insurer’s 30-day pay-or-notify clock and an 18-month limit on recouping an erroneous payment (“unless such action is initiated within 18 months after the end of the month in which the erroneous payment was made”), but no deadline for a provider to file. Confirm the window in your contract or with Aetna provider services before the first claim.[14][20]
Aetna’s ABA documents name CPT codes only. Its behavioral-health precertification list puts applied behavioral analysis under “97151, 97152, 97153, 97154, 97155, 97156, 97157, 97158, 0362T, 0373T.” Its ABA precertification request asks for hours by those same codes: assessment codes 97151, 97152 and 0362T per authorization period, treatment codes 97153–97158 and 0373T per week. CPB 0554 (reviewed October 14, 2026) also lists 97151–97158, with 0362T and 0373T as related codes. None of these documents lists a HCPCS H-code (H0031, H0032, H2014, H2019) for ABA. If a plan or contract seems to call for one, confirm with Aetna before billing it.[17][16][1]
Aetna’s ABA Medical Necessity Guide sets the evidence for any authorization: “demonstration of functional impairment on a standardized scale of functioning in the past 12 months” (for instance VABS-3, ABAS, VB-MAPP or ABLLS), target behaviors with “frequency, rate, symptom intensity or duration, or other objective measures of baseline levels” and “quantifiable criteria for progress,” and either documentation that the target behavior has improved or, if not, documentation of treatment modification, added assessments or consultation. The level of impairment must justify the hours requested. The guide does not require graphs.[9][16]
Aetna’s precertification information request (GR-69017-4, effective August 1, 2026, used outside Maryland and Massachusetts) spells out the reauthorization package. It asks for a standardized assessment within the past 12 months, re-evaluation of interventions and progress “every 6 months,” “a repeat validated assessment … every 6-12 months to demonstrate response to intervention,” and a treatment plan that includes “baseline, interim and current data for all goals.” It also asks for measurable caregiver goals and titration and discharge criteria. Data, not graphs, is what the form names.[9][16]
The questions that decide whether a family can start with Aetna in Kansas, and what they have to bring. Each maps onto something intake should ask on the first call.
Aetna puts the recency clock on the functional assessment, not the diagnosis: medical necessity requires "demonstration of functional impairment on a standardized scale of functioning in the past 12 months," and the impairment must be at least one standard deviation below the population mean or represent a significant risk of harm to self or others. The ABA Medical Necessity Guide sets no expiry on the ASD diagnosis itself.[9]
"There is a DSM-V diagnosis of Autism Spectrum Disorder (ICD-10/ F84.0; F84.3 - F84.9) obtained by an appropriate provider (i.e. licensed psychologist/psychiatrist, physician or other health care professional qualified to diagnose mental health conditions within their scope of practice)." Note the code set the guide actually prints: F84.0 plus F84.3–F84.9, which leaves out F84.1 and F84.2.[9]
No diagnostic instrument is mandated; the named instruments sit on the functional-impairment test — "the Vineland Adaptive Behavior Scales 3 (VABS-3), the Adaptive Behavior Assessment Scale (ABAS), VB-MAPP or ABLLS" are given as examples of the standardized scale that must show impairment within the past 12 months.[9]
No referral or physician order is required by the national guide — the gate is the diagnosis "obtained by an appropriate provider" plus precertification. The only prescription requirement Aetna publishes is its Maryland exhibit (COMAR 31.10.39), where the child's primary care or specialty physician must perform the evaluation and prescribe the treatment with specific goals; that exhibit does not reach plans outside Maryland.[9]
Aetna publishes no commercial decision clock of its own: ABA "services require prior authorization. To get ABA services precertified, call the number on the member's Aetna ID card," and the manual sets no reauthorization lead time (none in the ABA Medical Necessity Guide or the ABA precert form either). The legal ceiling depends on funding. Kansas fully insured plans are held to the Insurance Department's utilization-management standards adopted by K.A.R. 40-4-41: prospective (pre-service) review "Within 15 calendar days of the receipt of request" (one 15-calendar-day extension, with at least 45 days to supply missing information) and "no later than 72 hours" for urgent care; an urgent request to extend a current course of treatment is decided within 24 hours if received "at least 24 hours before the expiration of the currently certified period." Self-funded ERISA plans land on the same numbers under 29 CFR 2560.503-1 (15 days, 72 hours urgent), so 15 calendar days / 72 hours from receipt is the ceiling either way.[14][22][23]
Aetna: "We coordinate benefits as allowed by state or federal law following the National Associations of Insurance Commissioners (NAIC) guidelines. If there is no applicable law, then we coordinate according to the member's plan" — the manual's order-of-benefits list includes the birthday rule for children whose parents are not separated or divorced. Kansas's COB rule (K.A.R. 40-4-34) governs fully insured plans: for a child whose parents are married or living together, "The plan of the parent whose birthday falls earlier in the calendar year is the primary plan" (same birthday: the plan that has covered the parent longest); for divorced or separated parents a court decree naming the responsible parent controls. Self-funded plans follow their plan document instead, and Aetna notes many use "Maintenance of Benefits (MOB)" rather than the "100% Allowable" method most state laws require, so a secondary payment can be smaller. If the child also has Medicaid, this plan pays first: Medicaid is payer of last resort (42 CFR 433.139) — bill here, then send the EOB or denial to Medicaid, and get Medicaid's own prior auth too if the state requires it. TRICARE is secondary to this plan ("TRICARE shall be last pay," 32 CFR 199.8), and "CHAMPVA is the last payer to OHI" (38 CFR 17.276(d)).[14][24][25][26][27]
K.S.A. 40-2,194 limits the mandate to covered individuals under age 12, on fully-insured large-group coverage only (51+ employees since 2023's SB 24), with ABA capped at 1,300 hours a year for four years for a child diagnosed between birth and age 5 and 520 hours a year otherwise — caps a plan may exceed with prior approval when medically necessary. Advocacy analysis (not a regulator determination) treats the under-12 limit and the hour caps as unenforceable quantitative treatment limits under MHPAEA for parity-covered plans, so treat an age- or cap-based denial as appealable rather than final. The carrier's national ABA policy sets no age bound of its own.[4][9]
Ask the plan: Benefits verification on the specific plan — funding type first, then the ABA benefit terms.
Aetna Behavioral Health "offers telehealth services to all commercial fully insured members and to all commercial self-insured plan sponsors, unless those self-insured plan sponsors opt out of telehealth services" (provider manual, 6/26), and its Telemedicine and Direct Patient Contact Payment Policy lists the ABA codes it pays by telehealth: on commercial plans 97151, 97153, 97155, 97156 and 97157, billed with modifier GT, 95 or FR (97152, 97154 and 97158 are checked for Medicare Advantage only; the posted policy shows a last review of June 2021). For a fully insured Kansas plan issued or renewed on or after 1/1/2019, K.S.A. 40-2,213 bars excluding "an otherwise covered healthcare service from coverage solely because such service is provided through telemedicine" when a healthcare provider (which the act defines to include anyone licensed by the BSRB) delivers it, and lets the carrier set telemedicine payment "in the same manner" as in person; it does not reach self-funded ERISA plans. Aetna's ABA Medical Necessity Guide says nothing about which ABA codes may be delivered remotely, or with which place-of-service code; the code list lives in the payment policy. What is published is the licensure condition. Aetna's Network Participation Criteria (5/26) require telehealth providers to “satisfy all applicable license, registration, and certification requirements noted in the participation criteria for all states in which members to whom they are providing Telehealth services are located,” and to hold the licenses the law requires where they are physically located. Only codes on Aetna's Telemedicine and Direct Patient Contact Payment Policy are payable by telehealth unless law requires otherwise. The provider manual adds that telehealth providers “must act within the scope of their license and ensure that they have the proper licensure based on state requirements,” and Kansas requires a BSRB license to “practice applied behavior analysis in this state” (K.S.A. 65-7503) — so a BCBA outside Kansas needs a Kansas LBA before treating a Kansas child by video.[9][21][14][3][10][11]
Ask the plan: Aetna's Telemedicine and Direct Patient Contact Payment Policy for the payable code list, and Aetna provider services at the number on the member's ID card — confirm before scheduling remote 97155 or 97156. Whether an out-of-state BCBA treating a child in Kansas by video is practicing "in this state" is a Kansas BSRB question (785-296-3240).
Coverage decides whether Aetna in Kansas pays. These decide whether the claim survives: how sessions must be staffed and supervised, what may be billed concurrently, the per-day ceilings, who signs the note, where the service is payable, and whose NPI the claim goes out under.
The ABA Medical Necessity Guide sets a duty: where a state mandate, plan document or contract allows services from someone neither state-licensed nor BACB-certified, "there must be supervision and direction of the unlicensed or non-certified providers in line with practice standards." Aetna's Network Participation Criteria (5/26) put a number on it for participating ABA providers: "A minimum of one hour of face-to-face supervision is required of the unlicensed or noncertified paraprofessional by a BCBA or licensed psychologist (or behavioral health professional) for each 10 hours of applied behavior analysis by the supervised provider. In addition, the supervisor must be onsite with the child at least one hour a month, face to face." Supervision policies and procedures "must be documented," and "All BCBAs, BCaBAs and paraprofessionals must meet state requirements."[9][3]
The claim carries the analyst, not the technician. "Services must be provided directly or billed by licensed behavior analysts (in states with behavior analyst licensure laws), board-certified behavior analysts, or licensed psychologists where behavior analysis is within their scope of practice definition, unless state mandates, plan documents or contracts require otherwise." The escape clause matters: a state mandate or your contract can move the line, so confirm before enrolling technicians.[9]
Aetna publishes no ABA place-of-service list. On school settings it says two things. CPB 0648: "Many Aetna plans exclude coverage of educational services. For example, speech therapy or ABA services during class would be excluded under these plans. Please check benefit plan exclusions." And precertification form GR-69017-4 asks "Are any ABA hours being requested during class?" and, if so, how many and for which codes. The IEP/IDEA carve-out in Aetna's ABA medical necessity guide sits in its Maryland exhibit, not in the national criteria. Where ABA is payable in a school, the community or a group home is a benefit-document question.[2][16]
Ask the plan: The member's benefit document (educational-services exclusion), and Aetna provider services for whether school-setting ABA is payable on that plan.
Not published. Neither the ABA Medical Necessity Guide nor Aetna's clinical policy bulletin on ABA addresses whether 97153 and 97155 may be billed for the same clock time; Aetna carries the concurrency question in its claim editing rather than in a public policy.
Ask the plan: Aetna precertification/provider services at the number on the member's ID card, and the plan's own reimbursement schedule — ask specifically whether 97155 pays alongside 97153 when analyst, technician and member are all face-to-face.
Not published. Aetna's ABA documents set medical-necessity criteria and precertification requirements for 97151–97158, 0362T and 0373T, but no per-day unit ceiling and no statement of which MUE table applies. The guide does publish typical intensity bands — comprehensive ABA 10–25 hours/week, focused ABA 1–20 hours/week — as clinical guidance, not claim edits.[9]
Ask the plan: Aetna provider services; confirm before promising a family more than four hours a day of 97153.
Not published in Aetna's ABA materials — no rule on who signs a session note or within what window.
Blocked on: The Aetna provider manual and your participation agreement's documentation clause.
Yes — under the carrier's national policy for ASD, layered on Kansas's mandate (K.S.A. 40-2,194) for fully-insured large-group plans. Self-funded employer plans are exempt from the mandate, so always verify plan funding type first.
For large-group (51+) fully-insured plans: coverage for members under 12, with ABA capped at 1,300 hours/year for 4 years when diagnosed by age 5, otherwise 520 hours/year — exceedable with prior approval when medically necessary. Federal parity analysis questions whether the age limit and hour caps are enforceable, so treat cap denials as appealable.
Not anymore — Aetna Better Health of Kansas lost the KanCare 3.0 contract and its members moved to Healthy Blue Kansas on 1/1/2025. Aetna cards in Kansas today are commercial.
Aetna publishes no Kansas-specific rule either way. Its provider manual requires network credentialing, BACB certification or a behavior-analyst license “in the state in which they practice,” and, for telehealth, “the proper licensure based on state requirements.” Kansas requires a BSRB license to “practice applied behavior analysis in this state” (K.S.A. 65-7503), the mandate pays only providers “licensed or exempt from licensure under the applied behavior analysis licensure act” (K.S.A. 40-2,194), and the telemedicine-parity law protects only BSRB-licensed providers. Aetna's Network Participation Criteria (5/26) go further for telehealth: providers must meet the license requirements "for all states in which members to whom they are providing Telehealth services are located." Get a Kansas LBA before treating a Kansas child remotely, then confirm with Aetna Credentialing Customer Service (1-800-353-1232) that the Kansas license is on your credentialing file.
Aetna publishes no ABA rates. Its provider manual says payment follows “the rates and compensation under your agreement,” so the numbers are in your Aetna participation agreement. KanCare's 97153 rate ($16.25 per 15 minutes, KMAP Bulletin 24125) is the public benchmark.
No published rule requires one. Aetna treats behavioral health as direct access, and its clean-claim definition asks for a referral only "if required for the applicable claim." Precertification is the gate.
No published rule either way. Aetna's precertification form asks which PT, OT, speech and other services the child gets and whether you coordinate with them, so disclose them and confirm with precertification before overlapping sessions.
Form GR-69017-4 (7-26), which since August 1, 2026 replaces all other Aetna ABA precertification forms (except in Maryland and Massachusetts). Start the request on Availity or by phone first, then attach the form if the case pends. Request 97151, 97152 and 0362T in hours per authorization period.
Aetna’s provider manual publishes no number, and Kansas’s prompt payment act sets no provider filing deadline, so your participation agreement controls. Check the contract or ask Aetna provider services; the act does bar Aetna from recouping an erroneous payment more than 18 months after the month it was paid, except for fraud.
Aetna’s precertification list, its ABA precertification request and CPB 0554 list only CPT 97151–97158, 0362T and 0373T for ABA. No H-code appears in them, so bill the CPT codes unless Aetna tells you otherwise for a specific plan.
Aetna’s documents ask for data, not graphs: a standardized functioning assessment within the past 12 months, baseline and quantifiable progress measures for each target behavior, and documentation of improvement or of treatment changes. Its precertification request also asks for baseline, interim and current data for all goals and a repeat validated assessment every 6–12 months.
Payer policies change frequently and vary by plan, state, and funding type. This guide was compiled from the sources above and last reviewed October 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.
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