MedicaidBilling CodesMedium impact
KMAP BULLETIN: PD Waiver - PCS in Congregate Settings
Kansas Medicaid (KanCare)·KS · Physical Therapy, Occupational Therapy·Specialty Services
Effective date
Apr 1, 2024
We identified it
Jun 21, 2026
Summary
Kansas Medicaid's HCBS Physical Disability waiver now requires using code S5125 with UA modifier for Personal Care Services provided in congregate settings like assisted living facilities, effective April 1, 2024. This replaces previous coding requirements for PCS in these specific settings.
Action Required
Immediately: Billing team must update system to use HCPCS code S5125 with UA modifier for all Personal Care Services provided in congregate settings (licensed assisted living, residential health care, home plus, or boarding care facilities) for Kansas Medicaid HCBS Physical Disability waiver patients. Update encounter forms and notify providers of the new coding requirement. Monitor the KanCare Open Claims Resolution Log for MCO implementation status as timing may vary by managed care organization.