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KMAP BULLETIN: Coverage Guidance and Rate Updates for CPT Codes 81229 and 81243

Date: 06/04/20

KMAP GENERAL BULLETIN 20122 (PDF)

Effective with date of service July 1, 2020, the rates for procedure codes 81229 and 81243 which are used to test for Global Developmental Delay (GDD) and Fragile X Syndrome have been updated.

Acceptable ICD-10 diagnosis codes for GDD and Fragile X Syndrome include but is not limited to the following:

  • F84.0
  • F84.3
  • F84.5
  • F84.8
  • F84.9
  • F88.0
  • Q99.2

Note: This information is provided for guidance only, as these CPT codes may be used to identify conditions other than Global Development Disorder and Fragile X Syndrome.

Note: The effective date of the policy is July 1, 2020. The implementation of State policy by the KanCare managed care organizations (MCOs) may vary from the date noted in the Kansas Medical Assistance Program (KMAP) bulletins. The KanCare Open Claims Resolution Log on the KMAP Bulletins page documents the MCO system status for policy implementation and any associated reprocessing completion dates, once the policy is implemented.