Blue Cross and Blue Shield of Kansas is the Blue plan for Kansas; by its own description it "serves all counties in Kansas except Johnson and Wyandotte." For ABA it works through Lucet: BCBSKS says "Lucet’s medical policy is used to review and make benefit decisions for ABA service requests," and both the pre-treatment assessment and treatment need Lucet authorization. Its 2026 Autism manual adds the operating rules that decide claims: who can enroll, how many cases a BCBA should carry, no concurrent ABA billing, and telehealth limited to parent education and supervision.
BCBSKS puts "Applied Behavior Analysis (ABA) therapy services" on its list of medical services requiring prior authorization, with 877-563-9347 for assistance. Lucet’s plan grid for BCBSKS routes ABA authorization for PPO, EPO and FEP members to Lucet by fax 816-237-2372, phone 877-563-9347 or WebPass (it shows N/A for BCBSKS Medicare). Lucet’s policy 20.5.005 (in force 1/1/2026–12/31/2026) has three request types: a Pre-Treatment Assessment Request, an Initial ABA Treatment Authorization Request and a Continued ABA Treatment Authorization Request. The authorization "must be in the name of the BCBA who will be performing the services (e.g., 97151, 97155, 97156, 97157, 97158) or overseeing the technicians performing the services (e.g., 97152, 97153, 97154)."[2][8][7][1][9]
Timing: Lucet asks for requests "at least two weeks prior to authorization expiration," says "Reviews of authorization requests may take up to 15 days," and uses an ABA Amended Request form for provider changes, more or fewer hours, a new service location or added codes. BCBSKS’s manual says treatment plans are "usually reviewed for medical necessity twice annually – frequency dependent upon the controlling state mandate"; on fully insured Kansas plans, K.S.A. 40-2,194 lets the insurer review the treatment plan "not more than once in a period of six consecutive months" unless the insurer and the treating physician or psychologist agree otherwise.[2][8][7][1][9]
The diagnosis must come from "a clinician who is licensed and qualified to make such a diagnosis. Such clinicians are usually neurologists, developmental pediatricians, pediatricians, psychiatrists, licensed clinical psychologists or medical doctors experienced in the diagnosis of ASD. State law may define eligible qualified clinicians." Screening results do not count. Lucet’s manual names the diagnostic instruments: one of the ADOS-2, the ADI-R or a DSM-5 Checklist "is required to meet the diagnostic criteria."[7][8]
Treatment requests also need baseline data "completed no longer than five (5) years prior to or scheduled within ninety (90) days of the pre-treatment assessment": a developmental and cognitive evaluation, an autism-specific assessment of severity, an adaptive behavior assessment "completed within 6 months of start date of treatment," and a neurological evaluation as part of a physical exam. The manual lists the accepted adaptive tests (Vineland, ABAS, BASC, PDDBI) and cognitive tests (for example Bayley, Mullen, DAS, WPPSI, WISC) and treats VB-MAPP, ABLLS, PEAK, EFL and AFLS as optional curricular measures of progress.[7][8]
BCBSKS classifies treatment two ways. Comprehensive ABA, "primarily directed to children ages three to eight years old," runs "from 25 to 40 total hours of direct services weekly" and requires caregiver training. Focused ABA "typically range[s] from 10 to 25 total hours of direct services per week." Authorized hours depend on Lucet’s policy, the treatment plan, the member’s age, symptom severity and developmental functioning. Recommended BCBA caseloads: focused treatment 10–15 without an IIS/BCaBA (16–24 with one); comprehensive treatment 6–12 without (12–16 with).[1]
Excluded: services that duplicate school academics, respite, shadow, paraprofessional or companion services "in any setting," custodial care, ABA in residential facilities that replaces the facility’s own program, programs in "nonconventional settings" such as camps or resorts, and a long list of non-ABA therapies. "Services provided by tutors, special education teachers and paraprofessionals are not eligible under the Autism benefit."[1]
BCBSKS’s Autism manual: "BCBSKS does not allow billing of ABA services concurrently. Only one provider will be reimbursed for overlapping session times." All ABA codes are billed in 15-minute units, and "Session times on claims are recommended to reduce duplicate claim denials." Contracting providers bill "under their own billing National Provider Identifier (NPI) or specific rendering provider number," and Policy Memo No. 1 adds that "BCBSKS does not recognize incident-to billing" and that the ordering provider’s name and NPI must appear on the claim "when applicable."[1][3][5]
Policy Memo No. 1 (January 2026): "Claims must be filed within 15 months of the service date," or they are rejected with members held harmless. Only claims denied as not medically necessary can be appealed on the provider’s own behalf: a first-level written appeal within 60 days of the retrospective review determination, a second level within 60 days of that denial, and BCBSKS decides each within 60 days. For out-of-state Blue members (BlueCard), BCBSKS is the host plan: submit claims to BCBSKS unless the ID card says otherwise, while the home plan confirms benefits and applies its own medical policy.[1][3][5]
Policy Memo No. 1 sets the record rules: each entry must show the date of service and of the entry, "List start and stop times or total time for each CPT/CDT code/service performed on all timed codes," and "be authenticated by the person making the entry." A handwritten signature needs at least the first initial, full last name, credentials and date; an electronic signature must be automatically attached with the author’s name, credentials, date and time, and "After the entry is electronically signed, the text-editing feature should not be available for amending documentation." Rubber stamps are not allowed, and cloned or carried-forward notes "will not be considered."[3][8]
Corrections follow a fixed format. On paper: a single line through the error, the word "error," the reason and the correct information, signed with credentials, date and time. In an EHR, an addendum adds information to a signed entry and an amendment clarifies it; both are labelled, dated and timed, refer back to the original entry, are written "as soon after the original note as possible," and "should not be antedated." Lucet’s treatment-record guidelines add that entries must identify the rendering provider and be signed "by the individual providing the services," with each day’s service documented separately.[3][8]
K.S.A. 40-2,194 requires large-group policies, service-corporation contracts, fraternal benefit societies and HMOs issued or renewed from January 1, 2015 (grandfathered policies from January 1, 2016) to cover "the diagnosis and treatment of autism spectrum disorder in any covered individual whose age is less than 12 years." ABA is limited to 1,300 hours a year for four years for a child diagnosed between birth and age five, otherwise 520 hours a year under 12, but "Upon prior approval by the health benefit plan, such maximum benefit limit may be exceeded" when medically necessary. Since 2023 SB 24 a large employer is one with "at least 51 employees."[9]
Other terms that matter at intake: ABA is covered "when required by a licensed physician, licensed psychologist or licensed specialist clinical social worker"; reimbursement goes only to providers "licensed or exempt from licensure under the applied behavior analysis licensure act" or qualified under the HCBS autism waiver; dollar limits, deductibles and coinsurance may not be less favorable than for physical illness; a child diagnosed under one DSM edition need not be re-evaluated when a new edition is adopted; and the law does not require payment for day care, "school-based rehabilitative services" or services schools must provide. Small employers can be granted a waiver if compliance raised premiums 2.5% or more.[9]
Kansas requires a license to practise ABA: under K.S.A. 65-7503, since July 1, 2016 "no person shall practice applied behavior analysis in this state" unless a licensed behavior analyst, a licensed assistant working under one, a supervised trainee or a licensed psychologist, with exemptions for IDEA and Section 504 school services, HCBS autism waiver providers, and OTs, SLPs and other BSRB licensees within scope. BCBSKS credentials LBAs and LaBAs (license checked with the BSRB, CAQH profile required) and enrolls BCBA, BCBA-D, BCaBA, RBT, Autism Specialist and IIS providers as non-credentialed types, verified through the BACB or, for Autism Specialists and IIS, a KDADS HCBS autism waiver letter. Lucet requires a national criminal background check, including the National Sex Offender Registry, for every line therapist.[11][1][8]
The questions that decide whether a family can start with Blue Cross and Blue Shield of Kansas, and what they have to bring. Each maps onto something intake should ask on the first call.
No expiry on the diagnosis itself is published, and K.S.A. 40-2,194(c) bars re-evaluation just because a new DSM edition is adopted. The baseline testing is dated: it must be "completed no longer than five (5) years prior to or scheduled within ninety (90) days of the pre-treatment assessment," with the adaptive behavior assessment "completed within 6 months of start date of treatment"; Lucet’s manual asks for the adaptive and cognitive tests within 90 days of the pre-treatment assessment.[7][8][9]
"A clinician who is licensed and qualified to make such a diagnosis. Such clinicians are usually neurologists, developmental pediatricians, pediatricians, psychiatrists, licensed clinical psychologists or medical doctors experienced in the diagnosis of ASD. State law may define eligible qualified clinicians." Kansas’s mandate ties ABA to a licensed physician, licensed psychologist or licensed specialist clinical social worker.[7][9]
One of the ADOS-2, the ADI-R or a DSM-5 Checklist "is required to meet the diagnostic criteria." Baseline also needs a standardized adaptive test (Vineland, ABAS, BASC or PDDBI) and a standardized cognitive test (for example Bayley, Mullen, DAS, WPPSI or WISC). VB-MAPP, ABLLS, PEAK, EFL and AFLS are optional.[8][7]
No BCBSKS referral form. The authorization packet is the diagnostic evaluation plus Lucet’s Initial Treatment Plan form, with supporting records such as early-intervention reports and IEPs. Under K.S.A. 40-2,194 ABA is covered "when required by a licensed physician, licensed psychologist or licensed specialist clinical social worker," so on insured plans keep that recommendation in the file. Policy Memo No. 1 requires the ordering provider’s name and NPI on the claim "when applicable."[1][9][3]
"Telehealth/telemedicine for parent education and direct supervision activities can be covered if allowed as an eligible telehealth/telemedicine service under the member benefit plan," and BCBSKS recommends combining it with face-to-face supervision. Bill "with place of service 02 or 10 and the GT modifier." No other ABA code (assessment or technician treatment) is named as telehealth-eligible.[1][4]
Lucet: "Reviews of authorization requests may take up to 15 days." Submit continued-treatment requests "at least two weeks prior to authorization expiration."[8]
Lucet’s policy and BCBSKS’s manual set no upper age; comprehensive ABA is "primarily directed to children ages three to eight." On fully insured large-group and grandfathered Kansas policies the mandate floor is "any covered individual whose age is less than 12 years"; coverage beyond that depends on the member’s contract.[1][9]
Ask the plan: Checked the BCBSKS Autism manual (January 2026) and Lucet policy 20.5.005: no age cap stated. Confirm the member’s ABA benefit age limit with BCBSKS customer service (800-432-3990) or the benefit summary.
Coverage decides whether Blue Cross and Blue Shield of 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.
No percentage rule is published; BCBSKS sets recommended BCBA caseloads instead: focused treatment 10–15 cases without an IIS/BCaBA (16–24 with one), comprehensive treatment 6–12 without (12–16 with), depending on complexity, hours, modality and support staff. Line therapists are RBTs or BCaBAs, the supervising BCBA is responsible for their compliance, and each needs a national criminal background check. Kansas law requires an LaBA to work under an LBA.[1][8][11]
Not allowed. "BCBSKS does not allow billing of ABA services concurrently. Only one provider will be reimbursed for overlapping session times." Put session times on claims to avoid duplicate denials. When the BCBA does the technician’s work, that time counts toward the technician code.[1]
No per-day unit cap is published. Hours are set per authorization: comprehensive treatment 25–40 direct hours a week, focused 10–25. On fully insured plans K.S.A. 40-2,194 allows annual ABA caps of 1,300 hours (four years, diagnosed by age five) or 520 hours (under 12), exceedable with prior approval.[1][9]
Each entry must "be authenticated by the person making the entry" — the rendering provider signs their own note, and no supervisor co-signature rule is published. Handwritten: first initial, full last name, credentials and date; electronic: auto-attached name, credentials, date and time, with editing locked after signing; no rubber stamps. Start/stop times are required for timed codes. Corrections: on paper, strike through, mark "error," give the reason and sign with date and time; in an EHR, a labelled addendum or amendment, dated and timed, referring to the original entry and never antedated. Lucet requires each day’s service documented separately and signed by the person who provided it.[3][8]
No payable place-of-service list is published. Lucet requires treatment "in the setting and intensity that is appropriate," and comprehensive ABA should start "in a structured setting with 1:1 staffing" and move to the least restrictive environment. Excluded: services duplicating school academics, ABA in residential facilities replacing their own program, and programs in "nonconventional settings" (spas, camps, recreational or vocational settings). Telehealth uses POS 02 or 10. The mandate does not require payment for "school-based rehabilitative services."[1][7][9]
Contracting providers bill "under their own billing National Provider Identifier (NPI) or specific rendering provider number," and "BCBSKS does not recognize incident-to billing." The Lucet authorization is issued in the name of the BCBA who performs the service or oversees the technicians, so technician codes (97152–97154) bill against the supervising BCBA’s authorization.[1][3][8]
Yes, for autism spectrum disorder when Lucet’s medical necessity criteria (policy 20.5.005) are met and the member’s contract includes the benefit. Fully insured large-group and grandfathered Kansas policies must cover ASD treatment for children under 12 under K.S.A. 40-2,194.
Yes. ABA therapy services are on BCBSKS’s prior-authorization list, and Lucet reviews a Pre-Treatment Assessment Request before the assessment, issued in the name of the BCBA who will perform it. Call 877-563-9347, fax 816-237-2372 or use WebPass.
Lucet. BCBSKS’s Autism manual says Lucet’s medical policy is used for ABA benefit decisions; Lucet takes requests by fax 816-237-2372, phone 877-563-9347 or WebPass for PPO, EPO and FEP members, and reviews may take up to 15 days.
No. "BCBSKS does not allow billing of ABA services concurrently. Only one provider will be reimbursed for overlapping session times." Put session times on the claim.
Only parent education and direct supervision, and only if the member’s plan covers telehealth. Bill with POS 02 or 10 and modifier GT. BCBSKS recommends combining remote supervision with in-person supervision.
Policy Memo No. 1: on paper, draw one line through the error, write "error," the reason and the correct information, and sign with credentials, date and time. In an EHR, add a labelled addendum or amendment that refers to the original entry, dated and timed when written, as soon as possible and never antedated. The person who wrote the entry signs it.
15 months from the date of service under Policy Memo No. 1 (January 2026), unless an employer group sets a different limit; late claims are rejected with the member held harmless.
BCBSKS says it "serves all counties in Kansas except Johnson and Wyandotte." Out-of-state Blue members are served through BlueCard: claims go to BCBSKS as the host plan, while the member’s home plan sets benefits and medical policy.
We found no published BCBSKS ABA rate table. Under Policy Memo No. 1 contracting providers bill their usual charge and "accept payment allowances in all cases once notified of payment determination," and for BlueCard members "BCBSKS pricing is followed." For a public benchmark, KMAP’s Title XIX fee schedule (effective 10/1/2026) pays 97153 at $16.25 per 15-minute unit.
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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