MedicaidCoverageMedium impact
KMAP BULLETIN: Diagnosis Requirements for Evaluation and Management Services – Certified Community Behavioral Health Clinics
Kansas Medicaid (KanCare)·KS · Psychiatry·Specialty Services
Effective date
Jan 1, 2026
We identified it
Jun 21, 2026
Summary
Effective January 1, 2026, Kansas Medicaid will require Certified Community Behavioral Health Clinics (CCBHC) to have a primary diagnosis within ICD-10 range F01-F99 (behavioral health conditions) when billing specific E/M codes. This applies only to Provider Type 11, Provider Specialty 121 facilities providing services that include T1040.
Action Required
Before January 1, 2026: CCBHC billing teams must update billing system edits to require primary diagnosis codes F01-F99 when billing CPT codes 99211, 99212, 99213, 99214, and 99215 for Provider Type 11/Specialty 121. Update encounter forms and EMR templates to remind providers. Claims without qualifying behavioral health diagnoses will be denied for reimbursement.