Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.05-112 - Physician/Independent Lab/CRNA/Radiation Therapy Policy Update #107; Hospital/Critical Access/End-Stage Renal Disease Policy Update #88; Pharmacy Update #83; Official Notice DMS-2005-KK-3

Current through Register Vol. 49, No. 6, June, 2024
292.591
Injections and Oral
			 Immunosuppressive Drugs
A. The
			 following procedure codes for the administration of chemotherapy agents are
			 payable only if provided in a physician's office, place of service code: Paper
			 "3" or electronic "11." These procedures are not payable if performed in the
			 inpatient or outpatient hospital setting:
96400
96408
96414
96423
96545
96405
96410
96420
96425
96549
96406
96412
96422
96520
Only one administration fee is allowed per date of service
				unless "multiple sites" are indicated in the "Procedures, Services or Supplies"
				field in the CMS-1500 claim format. Supplies are included as part of the
				administration fee. The administration fee is not allowed when drugs are given
				orally.
Multiple units may be billed. Take-home drugs are not covered.
				Drugs loaded into an infusion pump are not classified as "take home
				drugs."
B. The following is
			 a list of covered therapeutic agents. Multiple units may be billed, if
			 appropriate. Take-home drugs are not covered. Drugs loaded into an infusion
			 pump are not classified as "take-home drugs."
For coverage information regarding any chemotherapy agent not
				listed, please contact the Medicaid Reimbursement Unit.
View
				or print Medicaid Reimbursement Unit contact
				information.
C. This list includes drugs covered for
			 recipients of all ages. However, when provided to individuals aged 21 or older,
			 a diagnosis of malignant neoplasm or HIV disease is required.
Procedure Codes
J0120
J0150
J0190
J0205
J0207
J0210
J0256
J0280
J0285
J0290
J0295
J0300
J0330
J0350
J0360
J0380
J0390
J0460
J0470
J0475
J0500
J0515
J0520
J0530
J0540
J0550
J0560
J0570
J0580
J0595*
J0600
J0610
J0620
J0630
J0640
J0670
J0690
J0694
J0696
J0697
J0698
J0702
J0704
J0710
J0713
J0715
J0720
J0725
J0735
J0740
J0743
J0745
J0760
J0770
J0780
J0800
J0835
J0850
J0895
J0900
J0945
J0970
J1000
J1020
J1030
J1040
J1051
J1060
J1070
J1080
J1094
J1100
J1110
J1120
J1160
J1165
J1170
J1180
J1190
J1200
J1205
J1212
J1230
J1240
J1245
J1250
J1260
J1320
J1325
J1330
J1364
J1380
J1390
J1410
J1435
J1436
J1440
J1441
J1455
J1570
J1580
J1610
J1620
J1626
J1630
J1631
J1642
J1644
J1645
J1650
J1670
J1700
J1710
J1720
J1730
J1742
J1750
J1785
J1800
J1810
J1815
J1825
J1830
J1840
J1850
J1885
J1890
J1910
J1940
J1950
J1955
J1960
J1980
J1990
J2000
J2001
J2010
J2060
J2150
J2175
J2180
J2185
J2210
J2250
J2270
J2275
J2280
J2300
J2353*
J2354*
J2310
J2320
J2321
J2322
J2360
J2370
J2400
J2405
J2410
J2430
J2440
J2460
J2505*
J2510
J2515
J2540
J2550
J2560
J2590
J2597
J2650
J2670
J2675
J2680
J2690
J2700
J2710
J2720
J2725
J2730
J2760
J2765
J2783*
J2800
J2820
J2912
J2920
J2930
J2950
J2995
J3000
J3010
J3030
J3070
J3105
J3120
J3130
J3140
J3150
J3230
J3240
J3250
J3260
J3265
J3280
J3301
J3302
J3303
J3305
J3310
J3320
J3350
J3360
J3364
J3365
J3370
J3400
J3410
J3430
J3465*
J3470
J3475
J3480
J3487*
J3490*
J3520
J7190
J7191
J7192
J7194
J7197
J7310
J7501
J7504
J7505
J7506
J7507*
J7508*
J7509
J7510
J7599*
J8530
J9000
J9001
J9010
J9015
J9020
J9031
J9040
J9045
J9050
J9060
J9062
J9065
J9070
J9080
J9090
J9091
J9092
J9093
J9094
J9095
J9096
J9097
J9098*
J9100
J9110
J9120
J9130
J9140
J9150
J9165
J9170
J9178*
J9181
J9182
J9185
J9190
J9200
J9201
J9202
J9206
J9208
J9209
J9211
J9212
J9213
J9214
J9215
J9216
J9217
J9218*
J9230
J9245
J9250
J9260
J9263*
J9265
J9266
J9268
J9270
J9280
J9290
J9291
J9293
J9300
J9310
J9320
J9340
J9355
J9360
J9370
J9375
J9380
J9390
J9600
J9999*
Q0163
Q0164
Q0165
Q0166
Q0167
Q0168
Q0169
Q0170
Q0171
Q0172
Q0173
Q0174
Q0175
Q0176
Q0177
Q0178
Q0179
Q0180
Q4075
S0115
S0187
*Procedure code requires paper billing.
The above injections may be provided in the physician's office.
				Multiple units may be billed.
Provider Manual Update Transmittal #88
REMOVE Section
Date
272.101
10-13-03
INSERT Section
Date
272.101
Explanation of
				Updates
Section 272. 101: In accordance with Section 1903(i) of the
				Social Security Act, as amended by section 104 of Public Law No. 109-91,
				procedure codes
J0270
and
J0275
are non-payable,
				effective for dates of service on and after January 1, 2006.
Paper versions of this update transmittal have updated pages
				attached to file in your provider manual. See Section I for instructions on
				updating the paper version of the manual. For electronic versions, these
				changes have already been incorporated.
If you need this material in an alternative format, such as
				large print, please contact our Americans with Disabilities Act Coordinator at
				(501) 682-6789 or 1-877-708 -8191. Both telephone numbers are voice and
				TDD.
If you have questions regarding this transmittal, please
				contact the EDS Provider Assistance Center at 1-800-457 -4454 (Toil-Free)
				within Arkansas or locally and Out-of-State at (501) 376-2211.
Arkansas Medicaid provider manuals (including update
				transmittals), official notices and remittance advice (RA) messages are
				available for downloading from the Arkansas Medicaid website:
				www.medicaid.state.ar.us.
Thank you for your participation in the Arkansas Medicaid
				Program.