Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.19-013 - Hospital 3-19 Spinal Muscular Atrophy Newborn Screening

Current through Register Vol. 49, No. 6, June, 2024
272.450
Special Billing Requirements
			 for Laboratory and X-Ray Services 1-1-20
The following codes have special billing requirements for
				laboratory and X-Ray procedures.
A.
			 CPT and HCPCS Lab Procedure Codes with Diagnosis Restrictions
The following CPT procedure codes will be payable with a
				primary diagnosis as is indicated below.
Procedure Code
Required Primary Diagnosis
Special Instructions
81479
None
Requires paper billing with attachments that describe
						  and justify the service represented by this procedure.
81500
81503
(View ICD Codes.)
18y and up. This code is restricted to female
						  beneficiaries. Requires paper billing that describes and justifies the
						  procedure.
81508
81509
Diagnosis must indicate a
current
condition of pregnancy.
None
81510
81511
81512
81599*
None
For consideration of claims with unlisted procedure
						  codes, such as
81599,
see Section 252.111 for billing instructions
						  on this unlisted procedure code.
82777
(View ICD Codes.)
18y and up
83951
(View ICD Codes.)
None
86386
(View ICD Codes.)
None
86828
(View ICD Codes.)
None
86829
86830
86831
86832
86833
86834
86835
87389
(View ICD Codes.)
None
87901
None
A maximum of 12 units per 12-month period
87903
None
A maximum of 1 unit per year
87904
None
This procedure code is an add-on code.
87906
None
A maximum of 12 units per 12-month period
88720
(View ICD Codes.)
None
88740
(View ICD Codes.)
None
88741
(View ICD Codes.)
None
B.
			 Genetic Testing
Procedure Code
Payment Method
S3831
Manually priced with no age or diagnosis
						  restrictions
S3840
S3844
S3846
S3849
S3850
S3853
S3861
S3800
Manually priced with no age or diagnosis restrictions;
						  requires Prior Authorization. This procedure code requires prior authorization
						  by AFMC based on the following criteria:
(1) an ICD diaanosis code of:
(View ICD
						  Codes.)
and symptoms of muscle weakness,
(2) documentation of muscle testing must be provided
						  and
(3) a completed evaluation by a neurologist to rule out
						  other causes of muscle weakness.
(See Section 241.000 regarding procedures for obtaining
						  prior authorization by AFMC.)
C.
Procedure Code
Description
83620
Newborn Metabolic Screening Panel
Arkansas Code §
										20-15-302
				states that all newborn infants shall be tested for certain metabolic diseases.
				Arkansas Medicaid shall reimburse the enrolled Arkansas Medicaid hospital
				provider that performs the tests required for the cost of the tests. Newborn
				Metabolic Screenings performed inpatient are included in the interim per diem
				reimbursement rate and facility cost settlement. For Newborn Metabolic
				Screenings performed in the outpatient setting (due to retesting or as an
				initial screening), Arkansas Medicaid will reimburse the hospital directly. For
				the screenings performed in the outpatient hospital setting, the provider will
				submit a claim using procedure code S3620. All positive test results shall be
				sent immediately to the Arkansas Department of Health.
The list of metabolic diseases for which providers can bill
				under S3620 can be found within the
Arkansas Department of Health (ADH)
				rules pertaining to testing of newborn
				infants.