MedicaidPrior AuthMedium impact
KMAP BULLETIN: PRTF Clinical Requirements
Kansas Medicaid (KanCare)·KS · Psychiatry, Pediatrics·Medical Policy
Effective date
Jun 15, 2017
We identified it
Jun 21, 2026
Summary
Kansas Medicaid now requires psychiatric diagnostic evaluations and potentially Community Based Services Team meetings for all children/youth seeking admission to Psychiatric Residential Treatment Facilities. New billing codes and same-day billing restrictions have been established for these evaluations.
Action Required
Immediately: Billing team must update system rules to prevent billing both CPT 90791 and 90792 on the same day for Kansas Medicaid PRTF evaluations. Allow same-day billing of 90791/90792 with H0032-HA (CMHC/CCBHC only), H0031, and H0032. Update encounter forms to remind providers that psychiatric diagnostic evaluations must be conducted face-to-face using approved methods. Train staff that MCO prior authorization may require both evaluations and CBST meetings.