MedicaidDocumentationHigh impact
KMAP BULLETIN: Autism Diagnosis and Diagnosticians Clinical Requirement
Kansas Medicaid (KanCare)·KS · Psychiatry, Pediatrics, Neurology +2 more·Medical Policy
Effective date
Sep 1, 2026
We identified it
Aug 15, 2026
Summary
Effective September 1, 2026, Kansas Medicaid (KMAP) now requires that autism spectrum disorder diagnoses for individuals aged 20 and younger must be made by a KMAP-approved clinical psychologist or qualified physician (including pediatricians, neurologists, psychiatrists, and family practitioners). Diagnoses must include DSM criteria assessment and validated ASD diagnostic tools (ADOS or CARS). Billing teams must verify provider qualifications and ensure diagnostic documentation meets these requirements before processing claims for ASD-related services.
Action Required
By August 1, 2026: (1) Billing team must create and maintain a verified list of qualified ASD diagnosticians including BSRB-licensed clinical psychologists and physicians with documented ASD training (providers with specialty codes 11/112, 31/316, 31/318, 31/326, 31/339, 31/345, 31/349, 31/351); (2) Update billing system to flag all ASD diagnosis claims (ICD-10 F84.x codes) for patients aged 20 and younger with a requirement to verify the diagnosing provider is on the approved list; (3) Implement an encounter form checklist for providers documenting that diagnostic evaluation includes DSM criteria assessment and at least one validated ASD tool (ADOS, CARS, or equivalent); (4) Train front desk and billing staff to request and verify diagnostic documentation (including tool used and cognitive/adaptive behavior evaluations) before claim submission; (5) Establish a denial management process for claims lacking qualified diagnostician documentation—these will be denied by KMAP. Beginning September 1, 2026, all ASD diagnosis claims must include provider qualification verification or claims will be rejected.