MedicaidCoverageMedium impact
KMAP BULLETIN: Deactivation of MUE Editing for BI Waiver Codes 97535 and 97537
Kansas Medicaid (KanCare)·KS · Occupational Therapy, Physical Therapy, PM&R (Physical Medicine & Rehab)·Specialty Services
Effective date
Feb 1, 2024
We identified it
Jun 21, 2026
Summary
Effective February 1, 2024, Kansas Medicaid has deactivated the Medically Unlikely Edits (MUE) limits for CPT codes 97535 and 97537 specifically for Brain Injury waiver members, allowing more units per day. Claims previously denied for exceeding MUE limits will be automatically reprocessed, but MUE overrides for 97130 are no longer allowed.
Action Required
Immediately: Billing team should review and resubmit any claims for CPT codes 97535 and 97537 that were denied for MUE limits for Brain Injury waiver patients since February 1, 2024, if not already reprocessed. Update billing system notes to reflect that MUE limits no longer apply to these codes for BI waiver members only. Stop requesting MUE overrides for CPT 97130 as these will no longer be approved.