---
title: Healthy Blue Kansas ABA coverage (KanCare MCO).
url: "https://carelu.com/payers/healthy-blue-kansas"
markdown_url: "https://carelu.com/payers/healthy-blue-kansas.md"
state: KS (Kansas)
payer: Healthy Blue Kansas
kind: Medicaid managed care plan (MCO)
parent_program: KanCare (Kansas Medicaid)
description: "How Healthy Blue Kansas — the KanCare MCO that replaced Aetna Better Health on 1/1/2025 — handles autism services: Availity prior authorization, the ASD testing request form, Anthem-platform mechanics, and what isn't publicly published yet."
last_reviewed: October 2026
vob_data_updated: 2026-10-15
---

# Healthy Blue Kansas ABA coverage (KanCare MCO).

_Payer Guide · Healthy Blue Kansas · Last updated October 2026 · 18 primary sources_

> Newest MCO (1/1/2025, absorbed Aetna members); Availity intake, own autism-testing form, thin public policy.

Healthy Blue Kansas is the newest KanCare MCO, live January 1, 2025 as a three-way collaboration of Blue Cross and Blue Shield of Kansas, Blue Cross and Blue Shield of Kansas City, and Anthem/Elevance — which is why its provider machinery is Anthem-platform (Availity) even though it isn't a plain Elevance subsidiary. It matters for intake because it absorbed most Aetna Better Health of Kansas members automatically at launch, so a large block of ABA cases changed payers at once. Honesty note up front: of the three KanCare MCOs, Healthy Blue publishes the least ABA-specific policy — no Kansas hour rules or review cadence appear on its public pages — so the state CCTS/IIS baseline plus portal verification is the working rulebook.

This plan administers the **KanCare (Kansas Medicaid)** ABA benefit: the state rules are the floor, and this page covers what the plan layers on top. Read it together with the [KanCare (Kansas Medicaid) guide](https://carelu.com/payers/kansas-medicaid).

## Prior authorization and diagnosis at a glance

- **Prior auth for the assessment**: Required — dedicated Autism Spectrum Disorder Testing request form (KSHB-CD-066296-24), which flags whether the request is to access ABA services [1][2]
- **Prior auth for treatment**: Required — via Availity (preferred), phone, or BH outpatient fax 1-866-852-8978; hour rules and review cadence not published — verify in the portal [1]
- **Autism diagnosis required?**: Yes — ASD, under the KanCare CCTS/IIS benefit. Healthy Blue publishes no diagnosis rule of its own, so the KMAP-wide rule binds: per Bulletin 26140 (reissued 8/31/2026, effective 11/1/2026), members 20 and under must be diagnosed by a Kansas BSRB-licensed clinical psychologist or a qualified physician, documented against DSM criteria and severity level using a validated tool such as ADOS or CARS, with a 2-year grace period for members already diagnosed by a non-qualifying provider [5][7][1]

## At a glance

- **Plan type:** KanCare MCO — new 1/1/2025 (BCBSKS + BCBS Kansas City + Anthem/Elevance JV)
- **Aetna transition:** Absorbed most Aetna Better Health members 1/1/2025; continuity-of-care auths honored at transition
- **Prior auth:** Required — Availity preferred; BH outpatient fax 1-866-852-8978
- **Assessment form:** Dedicated ASD Testing request form (KSHB-CD-066296-24)
- **Hour rules:** Not published — state soft limits (50 h/yr CCTS, 25 h/wk IIS) are the KanCare baseline
- **Clinical guidelines:** Anthem/Elevance UM guideline library on healthybluekansas.com

## What's verified about Healthy Blue's ABA process

Prior authorization submits through Availity (Patient Registration > Authorizations & Referrals), or by phone or fax — behavioral-health outpatient fax 1-866-852-8978 (inpatient 1-866-852-8976) — and the site hosts a Prior Authorization Lookup Tool for code-level questions. Autism and psychological testing use distinct paper forms: the Autism Spectrum Disorder Testing request (KSHB-CD-066296-24) versus the psychological-testing form (KSHB-CD-066293-24) — using the wrong one delays the assessment auth. The autism form includes whether the request is to access ABA services, and the plan's site indicates ABA therapy requires prior authorization (ABA line 877-563-9347). Clinical criteria come from the Anthem/Elevance UM guideline library published on the plan site; internal Anthem BH staff run UM — no external ABA vendor was identified on the pages we reviewed. [1][2]

## What isn't published — and the Aetna transition

We found no published Kansas-specific ABA hour caps, review cadence, or diagnosis-recency rule for Healthy Blue — the biggest verification gap among the three MCOs. Until the plan publishes more, work from the KanCare baseline (CCTS 50 hours/year, IIS 25 hours/week initial, state PA requirement) and confirm specifics through Availity or the ABA line before promising families a timeline. One state-level rule does bind here regardless of what Healthy Blue itself has published: KMAP Bulletin 26140 (eff. 11/1/2026) requires that for members 20 and under, the ASD diagnosis come from a Kansas BSRB-licensed clinical psychologist or a qualified physician, using a validated diagnostic tool — a KMAP-wide EPSDT rule, not an MCO-specific one, so it applies to Healthy Blue members too even though the plan has no Healthy-Blue-branded page stating so. On the transition: Aetna Better Health of Kansas served KanCare 2019–2024 and was not selected for the 2025–2027 contracts; its members auto-moved to Healthy Blue on 1/1/2025 (with an extended MCO-change deadline of 4/4/2025), and continuity-of-care authorization honoring applied at the switch. Any family or directory record still pointing at Aetna Better Health belongs here now — or at Sunflower or UHC if they actively switched. [4][6][5]

## Can an out-of-state BCBA treat a Kansas member, including by telehealth?

Kansas licenses the practice: “no person shall practice applied behavior analysis in this state unless they are” a licensed behavior analyst, a licensed assistant behavior analyst under LBA supervision, a supervised trainee, or a licensed psychologist (K.S.A. 65-7503(a)). The exemptions cover people providing services under IDEA or Section 504 and providers qualified under the HCBS autism waiver, not out-of-state analysts. The statute does not say in terms whether video sessions with a child located in Kansas are practice “in this state,” so the safe plan is a Kansas LBA (Behavioral Sciences Regulatory Board) before the first remote session. [13][14]

For KanCare, enrollment runs through KMAP. We have not verified KMAP’s rules for enrolling an out-of-state ABA provider, so ask KMAP provider enrollment before treating a KanCare member from another state. [13][14]

Federal rules make the state Medicaid enrollment rule binding on the plan: the state “must screen and enroll, and periodically revalidate, all network providers” of Medicaid managed care plans (42 CFR 438.602(b)(1)). So a BCBA in Healthy Blue’s network has to be enrolled with Kansas Medicaid (KMAP) as well. [13][14]

## Claims: filing deadline and payment disputes

Healthy Blue’s June 2026 manual: "Generally, paper and electronic claims must be filed within 180 days," corrected claims and other rebilling within 365 days of the date of service, and retroactive-eligibility claims within 180 calendar days of the eligibility determination; your contract’s own filing period controls where it differs. A claim payment reconsideration (optional) is accepted by phone, online or in writing "within 120 calendar days (plus an additional three (3) calendar days to allow for mailing/sending) of the date on the Explanation of Payment (EOP)." Healthy Blue’s manual scopes electronic visit verification to EVV-covered HCBS personal care and home health services, not ABA. [15]

Payment: the same manual commits Healthy Blue to process “100 percent of all clean claims, including adjustments processed and paid or processed and denied within 30 calendar days of receipt,” 99 percent of non-clean claims within 60 calendar days and 100 percent of all claims within 90 calendar days. Payment goes by EFT (enroll through EnrollSafe), virtual credit card or, for providers enrolled in neither, paper check. The manual publishes no weekly check-run day or submission cutoff. [15]

## Does Healthy Blue require a referring provider on the ABA claim (box 17)?

Healthy Blue's June 2026 KanCare manual does not list ABA among services that need a referring provider. It does say its systems "validate billing, rendering, and referring provider information against Healthy Blue and KanCare files" and check "processing rules such as a requirement for referral, prior authorization, or NDC." So any referring provider you report must match an enrolled KanCare record. [15][7]

The state's own gate is a recommendation "by a physician or other licensed practitioner" plus prior authorization, so keep the recommending clinician's name and NPI with the authorization packet. [15][7]

## Which codes does Healthy Blue pay for autism services? (H-codes)

Healthy Blue publishes no ABA code list of its own. Its 2026 KanCare manual lists Applied Behavior Analysis among the services needing prior authorization, but its HCPCS tables cover HCBS waiver services and send providers to the KMAP manuals for billing; it has no ABA code table. The state code set therefore applies. KMAP Bulletin 18259 put the autism services on CPT codes from January 1, 2019 (97151, 97152, 97153, 97155, 97156). Bulletin 24125 added 97153, 97154 and 97158 for CCTS providers and 97154 for IIS providers from July 1, 2024. Neither bulletin names a HCPCS H-code for CCTS or IIS. Confirm any H-code with Healthy Blue before billing it. [15][16][17]

## Intake gates

The questions that decide whether a family can start with Healthy Blue Kansas, and what they have to bring.

- **Age limit**: Healthy Blue publishes no Kansas-specific ABA rule on this point — its public prior-authorization pages and its ASD testing form carry none — so the KanCare state floor governs: CCTS and IIS are State Plan services under EPSDT, and KMAP Bulletin 26140 fixes the diagnostician rule for "individuals aged 20 years and younger." [1][7][5]
- **Diagnosis recency**: Healthy Blue publishes no Kansas-specific ABA rule on this point — its public prior-authorization pages and its ASD testing form carry none — so the KanCare state floor governs: KMAP Bulletin 26140 — reissued 8/31/2026 with its effective date moved from September 1 to November 1, 2026 — states that once an individual is diagnosed by a qualified diagnostician under that policy, "they are eligible for autism treatment, including applied behavioral analysis (ABA) therapy, without the need for a re-evaluation of their autism spectrum disorder diagnosis. There is also no time limit on how soon they begin autism treatment... following their diagnosis of autism spectrum disorder." Optum's current State Mandates supplement (BH803ABASTM72026, July 2026 — its revision log reads "07/21/2026 Interim Review: KS Medicaid") carries that language verbatim for Kansas Medicaid members and states no 6-month validation rule anywhere in the document. Sunflower's KS.CP.01, last reviewed 06/2019, still requires that an "MD or licensed psychologist has evaluated w/in last 6 months for current validation of Autism diagnosis" — but that policy no longer appears on Sunflower's clinical-policy index, which (checked 9/27/2026) lists Centene's CP.BH.104 (revised 02/26) as its Medicaid ABA policy. CP.BH.104 accepts a comprehensive diagnostic evaluation "conducted in the past three years" for treatment initiation, defers to "state-defined ABA criteria" for Medicaid plans, and, like KS.CP.01, says that where state Medicaid provisions conflict, "state Medicaid coverage provisions take precedence." Members already in treatment who were diagnosed by a non-qualifying diagnostician have two years to obtain an updated diagnosis, which "does not necessarily need to involve a complete diagnostic evaluation." [1][5]
- **Who may diagnose**: Healthy Blue publishes no Kansas-specific ABA rule on this point — its public prior-authorization pages and its ASD testing form carry none — so the KanCare state floor governs: Since KMAP Bulletin 26140, for members age 20 and younger the ASD diagnosis must come from a Kansas Behavioral Sciences Regulatory Board (BSRB) licensed clinical psychologist or a qualified physician, with a multidisciplinary approach preferred. The bulletin lists the qualifying provider type/specialty codes: 11/112 Psychologist, 31/316 Family Practitioner, 31/318 General Practitioner, 31/326 Neurologist, 31/339 Psychiatrist, 31/345 General Pediatrician (Developmental), 31/349 Exempt License Physician and 31/351 Indian Health Services (the KMAP-hosted PDF of the updated bulletin omits 31/349, which Sunflower's repost and Optum's criteria both list — confirm an exempt-license physician with the MCO). A qualifying BSRB clinical psychologist needs a doctoral degree in psychology or equivalent training plus two years of supervised experience delivering BSRB-approved psychological services; qualifying physicians — developmental/behavioral pediatricians, psychiatrists, neurologists and primary care physicians — need documented additional training in ASD diagnosis, which Optum notes "may be subject to periodic Optum audit/inquiry." [1][5]
- **Diagnostic tools required**: At state level: The diagnostic evaluation must document DSM criteria and symptom severity level and must rest on "a validated ASD diagnostic assessment tool such as the Autism Diagnostic Observation Schedule (ADOS) or the Childhood Autism Rating Scale (CARS)." Screening tools — M-CHAT, ABC, ASSQ, RITA-T, STAT — "have clinical value in recognizing children at risk of having ASD, but the diagnosis of ASD must rest on validated diagnostic tools such as those listed above." Recommended additions: a cognitive evaluation using CAT/CLAMS, MSEL or Bayley (a school district's validated cognitive testing may be used), and an adaptive measure such as ABAS or Vineland. The plan's own ASD Testing request form (KSHB-CD-066296-24) asks which rating scales were administered before the testing request — ASRS, SCQ, SRS, MCHAT, CARS, GARS, GADS or other — and which assessment components were completed: psychiatric and medical history, clinical interview with the patient, interview with family members, direct observation, medical evaluation with hearing and vision screening, developmental screening evaluation by a physician or psychologist, evaluation by a speech-language pathologist, structured developmental and social history, consultation with school or other important persons, review of academic records/IEP, brief inventories and rating scales, and pertinent family history. The date of the diagnostic interview must be given. [5][2]
- **Referral required?**: State floor plus the plan's form discipline. KMAP requires "a recommendation... by a physician or other licensed practitioner" and prior authorization; Healthy Blue routes requests through Availity Essentials (Patient Registration > Authorizations & Referrals), by phone, or by behavioral-health outpatient fax 1-866-852-8978, and ASD testing must go on the dedicated ASD Testing request form (KSHB-CD-066296-24) rather than the psychological-testing form — the form itself asks "Is this a request to access ABA services?" and carries a provider signature and date. [7][1][2]
- **Telehealth**: Healthy Blue publishes no telehealth rule for the CCTS/IIS codes; its ASD Testing request form asks whether "services [are] being rendered in person or via telehealth," so the state rule applies. KMAP lists the ABA codes as telehealth-eligible. General Bulletin 21234 made place of service 10 (telehealth in the patient's home) valid from 1/1/2022, "in addition to existing POS code 02 (telehealth provided other than in a patient's home)," and its list of procedure codes allowed with POS 10 includes 97151, 97152, 97153, 97155 and 97156. So the CCTS assessment (97151/97152), technician IIS (97153), supervision with protocol modification (97155) and family guidance (97156) may be billed as telehealth; 97154, 97157 and 97158 are not on that list. Kansas law sets the floor: the telemedicine act "shall also apply to the Kansas medical assistance program," which may not "exclude an otherwise covered healthcare service from coverage solely because such service is provided through telemedicine" when a healthcare provider delivers it, though it may limit coverage to medically necessary services and may not require a member to use telemedicine instead of in-person care (K.S.A. 40-2,213). The bulletins set no in-person minimum for supervision. KMAP notes that MCO implementation "may vary from the date noted in the KMAP bulletins." [11][12][2]
- **Prior-auth decision time**: Healthy Blue's June 2026 manual: non-urgent pre-service requests are decided "Within seven calendar days following receipt of request." Urgent (expedited) requests are decided "as expeditiously as the member's health condition requires, but no later than 72 hours (three calendar days) after receipt of request." Urgent concurrent reviews are also 72 hours. Requests marked urgent that don't meet the criteria are reprocessed as non-urgent. If documentation is incomplete, the plan asks for more and, absent a reply, "the medical director will make a determination based on the information previously received." ABA is on the precertification list. For renewals, "A physician or health care provider can submit a medical prior authorization recertification request at least 60 calendar days prior to the expiration of the current authorization." File the ABA reauth well ahead of expiry. [15][19]
- **Other insurance (who pays first)**: "Medicaid acts as a secondary payer to all Third Parties, except for Special Health Services, Vocational Rehabilitation, Indian Health Services, and Crime Victim's Compensation Funds." Per 42 CFR 433.139(b), Healthy Blue rejects a claim when other coverage is on file, so "the provider must attempt to bill the other insurance prior to filing the claim." Pay-and-chase covers only "preventive pediatric care, including KAN Be Healthy" and prenatal care. "The provider must follow the rules of the primary insurance plan (such as obtaining prior authorization and filing within the primary insurance plan's timely filing period), or the related Healthy Blue claim will be denied." Put the primary's adjustment and remark codes on the claim, and bill only the remaining patient liability, never the contractual write-off. If the commercial plan excludes ABA, a blanket denial letter on the carrier's letterhead can stand in for per-claim denials. The manual does not say whether Healthy Blue's own ABA precert is required when it is secondary. [15][20]
  - Ask the plan: Healthy Blue Provider Services 833-838-2595: whether ABA precertification is required when a commercial plan is primary.

## Delivery and billing rules

Coverage decides whether Healthy Blue Kansas pays. These decide whether the claim survives: staffing and supervision, concurrent billing, per-day ceilings, who signs the note, where the service is payable, and whose NPI the claim goes out under.

- **Supervision**: Healthy Blue publishes no Kansas-specific ABA rule on this point — its public prior-authorization pages and its ASD testing form carry none — so the KanCare state floor governs: IIS technicians hold an RBT certificate "under the supervision of a BCBA" or qualify through the KDADS-letter pathway, and work "under the direction of the BCBA or other Qualified CCTS Practitioner." No Kansas percentage or caseload ratio is published. [1][8][9]
- **Daily limits / MUEs**: Healthy Blue publishes no Kansas-specific ABA rule on this point — its public prior-authorization pages and its ASD testing form carry none — so the KanCare state floor governs: CCTS carries an annual soft limit of 50 hours and IIS an initial authorization of up to 25 hours per week, with additional hours available on a demonstration of medical necessity. No per-day unit ceiling is published at either level. [1][10]
- **Bill as provider**: Healthy Blue publishes no Kansas-specific ABA rule on this point — its public prior-authorization pages and its ASD testing form carry none — so the KanCare state floor governs: every group and every individual needs their own KMAP ID before an MCO can pay, with a separate enrollment for each service location. On Healthy Blue's own forms the distinction is drawn between the professional administering the service, the provider NPI and tax ID, and the billing facility/group NPI and tax ID. The plan step: Healthy Blue's June 2026 manual says providers join through the KMAP portal, but "KMAP approval does not guarantee participation" and "You must be contracted and credentialed by Healthy Blue prior to providing services." Its credentialing scope covers practitioners "licensed, certified, or registered by the state to practice independently (without direction or supervision)"; "Certified Behavioral Analysts" go through a separate certification-requirement process; technicians are not on either list. The manual does not say how RBTs are loaded, so confirm roster handling with Healthy Blue Provider Services. [1][9][15][2]
- **Concurrent billing (97153 + 97155):** Not published / unverified. Verify via: Healthy Blue's Prior Authorization Lookup Tool and ABA line 877-563-9347, or Availity; the KMAP manuals were unreachable at this review. [1]
- **Place of service** _(ask the plan)_: Not published — neither by Healthy Blue nor at state level. [1]
  - Ask the plan: Healthy Blue's ABA line 877-563-9347 and the Prior Authorization Lookup Tool.

## What intake should collect for Healthy Blue Kansas

- **Prior-payer history:** Ex-Aetna Better Health families landed here 1/1/2025 — check for transition-honored auths and stale card details.
- **The right testing form:** ASD testing uses KSHB-CD-066296-24, not the psychological-testing form (KSHB-CD-066293-24) — the wrong form delays the assessment auth.
- **ASD diagnosis + physician recommendation:** The state CCTS PA baseline applies; collect the diagnostic report and practitioner recommendation up front.
- **Portal-verified specifics:** Hour caps and review cadence aren't published — confirm per case via Availity or the ABA line 877-563-9347.

Free verification-call checklist (PDF): https://carelu.com/downloads/aba-verification-call-checklist.pdf

## Verification of benefits (VOB) data

How Healthy Blue Kansas ABA benefits route and read on an eligibility check. Data last updated 2026-10-15.

### EDI routing

- **Behavioral health administrator:** none — No Healthy Blue Kansas document reviewed states or disclaims a BH carve-out for ABA specifically — inferred "none" from internal Anthem BH staff running UM per the guide's own prose (no external ABA vendor identified).
- **ABA rides on:** medical benefit
- **Two-hop verification required:** No

### Code-level coverage

| Code | Covered | Prior auth | Unit cap | Place of service | Telehealth | Modifiers |
| --- | --- | --- | --- | --- | --- | --- |
| 97151 | Yes | Required — physician/licensed-practitioner recommendation + prior authorization, per MCO intake (KMAP Bulletin 17129) | Service-level, not per-code: CCTS soft limit 50 hrs/year; IIS initial authorization up to 25 hrs/week (more available on medical necessity). Billed under CCTS. per CCTS: year (soft limit); IIS: week (initial authorization) | — | Yes — on KMAP's telehealth list (Bulletin 21234, eff. 1/1/2022): bill POS 10 when the child is at home, POS 02 elsewhere; no telehealth modifier named in the bulletin. MCO implementation may vary. | — |
| 97152 | Yes | Required — physician/licensed-practitioner recommendation + prior authorization, per MCO intake (KMAP Bulletin 17129) | Service-level, not per-code: CCTS soft limit 50 hrs/year; IIS initial authorization up to 25 hrs/week (more available on medical necessity). Billed under CCTS. per CCTS: year (soft limit); IIS: week (initial authorization) | — | Yes — on KMAP's telehealth list (Bulletin 21234, eff. 1/1/2022): bill POS 10 when the child is at home, POS 02 elsewhere; no telehealth modifier named in the bulletin. MCO implementation may vary. | — |
| 97153 | Yes | Required — physician/licensed-practitioner recommendation + prior authorization, per MCO intake (KMAP Bulletin 17129) | Service-level, not per-code: CCTS soft limit 50 hrs/year; IIS initial authorization up to 25 hrs/week (more available on medical necessity). Billed under CCTS or IIS. per CCTS: year (soft limit); IIS: week (initial authorization) | — | Yes — on KMAP's telehealth list (Bulletin 21234, eff. 1/1/2022): bill POS 10 when the child is at home, POS 02 elsewhere; no telehealth modifier named in the bulletin. MCO implementation may vary. | — |
| 97154 | Yes | Required — physician/licensed-practitioner recommendation + prior authorization, per MCO intake (KMAP Bulletin 17129) | Service-level, not per-code: CCTS soft limit 50 hrs/year; IIS initial authorization up to 25 hrs/week (more available on medical necessity). Billed under CCTS or IIS. per CCTS: year (soft limit); IIS: week (initial authorization) | — | Not on KMAP's POS 10 telehealth code list (Bulletin 21234) — treat as in-person only unless the MCO confirms otherwise. | — |
| 97155 | Yes | Required — physician/licensed-practitioner recommendation + prior authorization, per MCO intake (KMAP Bulletin 17129) | Service-level, not per-code: CCTS soft limit 50 hrs/year; IIS initial authorization up to 25 hrs/week (more available on medical necessity). Billed under CCTS. per CCTS: year (soft limit); IIS: week (initial authorization) | — | Yes — on KMAP's telehealth list (Bulletin 21234, eff. 1/1/2022): bill POS 10 when the child is at home, POS 02 elsewhere; no telehealth modifier named in the bulletin. MCO implementation may vary. | — |
| 97156 | Yes | Required — physician/licensed-practitioner recommendation + prior authorization, per MCO intake (KMAP Bulletin 17129) | Service-level, not per-code: CCTS soft limit 50 hrs/year; IIS initial authorization up to 25 hrs/week (more available on medical necessity). Billed under CCTS. per CCTS: year (soft limit); IIS: week (initial authorization) | — | Yes — on KMAP's telehealth list (Bulletin 21234, eff. 1/1/2022): bill POS 10 when the child is at home, POS 02 elsewhere; no telehealth modifier named in the bulletin. MCO implementation may vary. | — |
| 97158 | Yes | Required — physician/licensed-practitioner recommendation + prior authorization, per MCO intake (KMAP Bulletin 17129) | Service-level, not per-code: CCTS soft limit 50 hrs/year; IIS initial authorization up to 25 hrs/week (more available on medical necessity). Billed under CCTS. per CCTS: year (soft limit); IIS: week (initial authorization) | — | Not on KMAP's POS 10 telehealth code list (Bulletin 21234) — treat as in-person only unless the MCO confirms otherwise. | — |

Code notes:

- **97151:** Comprehensive assessment, now billed under CCTS. Billable under this service since the 1/1/2017 State Plan CCTS/IIS transition. Verify via: Availity (Patient Registration > Authorizations & Referrals) or the ABA line 877-563-9347 — this plan's own published materials don't restate per-code unit caps or a modifier table beyond the state CCTS/IIS soft limits; the statewide KMAP pattern is applied here as inferred.
- **97152, 97155, 97156:** Billable under this service since the 1/1/2017 State Plan CCTS/IIS transition. Verify via: Availity (Patient Registration > Authorizations & Referrals) or the ABA line 877-563-9347 — this plan's own published materials don't restate per-code unit caps or a modifier table beyond the state CCTS/IIS soft limits; the statewide KMAP pattern is applied here as inferred.
- **97153:** Originally IIS-only (technician-delivered 1:1); CCTS was also authorized to bill this code effective 7/1/2024. Billable under this service effective 7/1/2024 — a later addition to the original 1/1/2017 CCTS/IIS code set. Verify via: Availity (Patient Registration > Authorizations & Referrals) or the ABA line 877-563-9347 — this plan's own published materials don't restate per-code unit caps or a modifier table beyond the state CCTS/IIS soft limits; the statewide KMAP pattern is applied here as inferred.
- **97154, 97158:** Billable under this service effective 7/1/2024 — a later addition to the original 1/1/2017 CCTS/IIS code set. Verify via: Availity (Patient Registration > Authorizations & Referrals) or the ABA line 877-563-9347 — this plan's own published materials don't restate per-code unit caps or a modifier table beyond the state CCTS/IIS soft limits; the statewide KMAP pattern is applied here as inferred.

### Medicaid rates

Source: KMAP interactive fee-schedule lookup is the stated source of truth but is not machine-accessible (SSO wall; re-confirmed blocked 2026-10-01). Last dated anchor for most codes: KMAP Bulletin 18259 set 97151 at $17.50/15-min unit effective 1/1/2019; KMAP Bulletin 19029 raised rates effective 4/1/2019 without publishing amounts; the 7/1/2022 BH increase (Bulletin 22128) explicitly excluded 9715x codes; the FY2024/2025/2026 HCBS rate bulletins (checked this pass) cover only BI/TA/I-DD HCBS waiver services and the separate HCBS Autism waiver code T2040, not State Plan CCTS/IIS. One exception found 2026-10-01: KMAP Bulletin 24125 verifies 97153 at $16.25/15-min unit ($65/hr) effective 7/1/2024 — the one current, dated rate in this table. Every other code remains unverified beyond the stale 2019 anchor. Effective 2019-01-01.

| Code | Rate | Unit | Modifier tiers |
| --- | --- | --- | --- |
| 97151 | $17.50 (stale 2019 anchor — raised 4/1/2019 by an unpublished amount; current figure unverified) | 15min | — |
| 97153 | $16.25 (verified, eff. 7/1/2024 — KMAP Bulletin 24125; equivalent to $65/hr) | 15min | — |

### Contacts

- **Provider services phone:** 1-877-563-9347 (Healthy Blue Kansas ABA line) — carried over from this corpus's existing citation of the plan's Prior Authorization Requirements page; a fresh re-fetch of that page this pass did not reproduce this number (only pharmacy and BH fax numbers were found), so confirm it's still current before relying on it.
- **Portal:** [Availity](https://apps.availity.com/availity/web/public.elegant.login)
- **Fax:** 1-866-852-8978 (behavioral-health outpatient fax)

Questions to ask on a verification call:

- Does Healthy Blue Kansas support real-time 270/271 eligibility checks, and what payer ID applies to this KanCare plan specifically (not generic BCBS Kansas)?
- What are Healthy Blue’s ABA unit caps, POS allowances, and telehealth modifier rules for CCTS/IIS codes?
- What is the current per-unit reimbursement rate for 97152 through 97158?
- Is there a currently working provider-services phone line for ABA eligibility questions, separate from the BH outpatient fax?

### VOB data sources

- https://pverify.com/wp-content/uploads/2026/03/pVerifyPayers_All-Payers-List-3-2026.pdf (accessed 2026-07-23)
- https://essentials.availity.com/availity/documents/payer_list_wShortNames.pdf (accessed 2026-07-23; source document older than 18 months)
- https://www.healthybluekansas.com/provider/state-federal/resources/prior-authorization-requirements (accessed 2026-07-23)
- https://www.kmap-state-ks.us/Documents/EDI/2017-05_270-271-DXC.pdf (accessed 2026-07-23; source document older than 18 months)
- https://www.sunflowerhealthplan.com/newsroom/kmap-17129.html (accessed 2026-07-23)
- https://www.sunflowerhealthplan.com/newsroom/kmap-19029.html (accessed 2026-07-23)
- https://portal.kmap-state-ks.us/Documents/Provider/Bulletins/21234%20-%20General%20-%20New_POS_Code_10.pdf (accessed 2026-07-23)
- https://www.sunflowerhealthplan.com/newsroom/kmap-18259.html (accessed 2026-07-23)
- https://www.sunflowerhealthplan.com/newsroom/kmap-221280.html (accessed 2026-07-23)
- https://www.sunflowerhealthplan.com/newsroom/kmap-24125.html (accessed 2026-10-01)
- https://www.sunflowerhealthplan.com/newsroom/kmap-24116.html (accessed 2026-07-23)
- https://www.sunflowerhealthplan.com/newsroom/kmap-25122.html (accessed 2026-07-23)
- https://portal.kmap-state-ks.us/PublicPage/ProviderPricing/FeeSchedules (accessed 2026-07-23; source document older than 18 months)

## Common questions

### Does Healthy Blue Kansas cover ABA therapy?

Yes — it administers the KanCare CCTS/IIS autism-services benefit under EPSDT, with prior authorization via Availity, phone, or fax. Plan-specific hour rules aren't published, so the state baseline plus portal verification governs.

### What happened to Aetna Better Health of Kansas members?

Aetna lost its KanCare contract; members auto-transitioned to Healthy Blue on 1/1/2025 (extended change deadline 4/4/2025) with continuity-of-care authorizations honored. Any listing showing Aetna Better Health as an active KanCare MCO is outdated.

### How do I submit an ABA authorization to Healthy Blue Kansas?

Availity is preferred (Patient Registration > Authorizations & Referrals); behavioral-health outpatient fax is 1-866-852-8978, and the plan lists an ABA line at 877-563-9347. Assessment requests use the dedicated ASD Testing form KSHB-CD-066296-24.

### Can ABA for this plan's KanCare members be delivered by telehealth?

Under the state rule, yes. KMAP Bulletin 21234 allows 97151, 97152, 97153, 97155 and 97156 with POS 10 (telehealth in the home), alongside POS 02 elsewhere; group codes 97154, 97157 and 97158 are not listed. The plan publishes no ABA telehealth rule of its own, so confirm the modality at authorization.

### Can an out-of-state BCBA treat Healthy Blue members in Kansas, including by telehealth?

Kansas requires a Kansas license to practice ABA “in this state” (K.S.A. 65-7503). Confirm KMAP enrollment before treating KanCare members from another state.

### What is Healthy Blue Kansas’s timely filing limit?

Generally 180 days from the date of service, and 365 days for corrected claims (June 2026 provider manual); your contract can set a different period.

### Does Healthy Blue Kansas require a referring provider on ABA claims?

Its manual names no ABA-specific rule, but it validates any referring provider you report against Healthy Blue and KanCare files, so the clinician must be enrolled.

### How fast does Healthy Blue Kansas pay a clean ABA claim?

Its June 2026 manual commits to paying or denying 100 percent of clean claims within 30 calendar days of receipt, 99 percent of non-clean claims within 60 days and all claims within 90 days. It publishes no weekly check-run schedule.

### Does Healthy Blue Kansas accept H0031 or H0032 for ABA?

Healthy Blue publishes no ABA code list, so KMAP’s state codes apply, and those bulletins name CPT codes only (97151–97156 and 97158 by provider type). Confirm any H-code with Healthy Blue first.

## Primary sources

1. [Healthy Blue Kansas — Prior Authorization Requirements](https://www.healthybluekansas.com/provider/state-federal/resources/prior-authorization-requirements)
2. [Healthy Blue KS — ASD Testing request form (KSHB-CD-066296-24)](https://www.healthybluekansas.com/content/dam/digital/healthyblue/documents/provider/ks/behavioral-health/KSHB-CD-066296-24-SRS66052%20BH%20Autism%20Testing%20Request%20Form_FINAL_v2%20FILLABLE.pdf)
3. [BCBSKS — Healthy Blue collaboration announcement (JV structure)](https://www.bcbsks.com/news-release/new-healthy-blue-collaboration-aims-offer-kansans-trusted-local-medicaid-solution-2024)
4. [Kansas Action for Children — KanCare 3.0 selection and Aetna transition](https://www.kac.org/state_selects_companies_to_manage_kancare)
5. [KMAP Bulletin 26140 — ASD diagnosis credential requirement (issued 8/12/2026; reissued 8/31/2026, eff. 11/1/2026)](https://www.sunflowerhealthplan.com/newsroom/kmap-26140.html)
6. [KDHE — KanCare MCO contract awards 2025–2027](https://www.kdhe.ks.gov/CivicAlerts.aspx?AID=1104)
7. [KMAP Bulletin 17129 — Additional State Plan Services (CCTS/IIS under EPSDT, eff. 1/1/2017)](https://www.sunflowerhealthplan.com/newsroom/kmap-17129.html)
8. [KMAP Bulletin 20147 — Autism CCTS & IIS provider qualification changes (eff. 4/3/2020)](https://www.sunflowerhealthplan.com/newsroom/kmap-20147.html)
9. [KMAP Bulletin 21013 — CCTS/IIS provider enrollment clarification](https://www.sunflowerhealthplan.com/newsroom/kmap-21013.html)
10. [KMAP Bulletin 19029 — Rate Increase for Autism Services (CCTS 50 h/yr, IIS 25 h/wk limits)](https://www.sunflowerhealthplan.com/newsroom/kmap-19029.html)
11. [KMAP General Bulletin 21234 — New Place of Service Code 10 (telehealth in the home; POS 10 code list incl. 97151–97153, 97155, 97156; eff. 1/1/2022)](https://portal.kmap-state-ks.us/Documents/Provider/Bulletins/21234%20-%20General%20-%20New_POS_Code_10.pdf)
12. [K.S.A. 40-2,213 — Kansas telemedicine act coverage parity (applies to the Kansas medical assistance program)](https://www.ksrevisor.gov/statutes/chapters/ch40/040_002_0213.html)
13. [K.S.A. 65-7503 — behavior analyst licensure required; exemptions](https://www.ksrevisor.gov/statutes/chapters/ch65/065_075_0003.html)
14. [eCFR — 42 CFR 438.602(b)(1): the state must screen and enroll all managed care network providers](https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-C/part-438/subpart-H/section-438.602)
15. [Healthy Blue Kansas Medicaid Provider Manual (June 2026): Payment of Claims](https://www.healthybluekansas.com/content/dam/digital/healthyblue/documents/provider/ks/general/KSHB-CD-PM-061368-24-EXPRESS-KanCare.pdf)
16. [KMAP Bulletin 18259 — Mental Health/Autism CPT crosswalk (eff. 1/1/2019)](https://www.sunflowerhealthplan.com/newsroom/kmap-18259.html)
17. [KMAP General Bulletin 24125 — Autism Codes: CCTS/IIS Coverage (eff. 7/1/2024)](https://www.sunflowerhealthplan.com/newsroom/kmap-24125.html)
18. [Healthy Blue Kansas — Provider News (provider news archive)](https://providernews.healthybluekansas.com/)
19. [42 CFR 438.210(d) — MCO authorization timeframes (eCFR)](https://www.ecfr.gov/current/title-42/section-438.210)
20. [42 CFR 433.139 — Medicaid third-party liability (eCFR)](https://www.ecfr.gov/current/title-42/section-433.139)

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.

Source: Carelu ABA Payer Directory — https://carelu.com/payers. Free to cite with attribution.