Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.05-069 - Hospital / Critical Access Hospital (CAH)/ End Stage Renal Disease (ESRD) Provider Manual Update Transmittal #84; Physician / Independent Lab / CCRNA / Radiation Therapy Center Provider Manual Update Transmittal #104; Nurse Practitioner Provider Manual Update Transmittal #60; Certified Nurse Midwife Provider Manual Update Transmittal #67

Current through Register Vol. 49, No. 6, June, 2024
Section
			 II Physician/Independent Lab/CRNA/Radiation Therapy Center
292.598
Influenza Virus Vaccine
A. Procedure code
90655,
influenza virus vaccine, split virus, preservative free, for children 6
			 to 35 months, is currently covered through the VFC program. Claims for Medicaid
			 beneficiaries must be filed using modifiers EP and TJ. When filing paper
			 claims, use type of service 6 with modifiers EP and TJ.
ForARKids First-B beneficiaries, use modifier TJ. When filing
				paper claims, use type of service 1 with modifier TJ.
B. Effective for dates of service on and
			 after October 1, 2005, Medicaid will cover procedure code
90656,
influenza virus vaccine, split virus, preservative free, for ages 3
			 years and older.
1. For individuals under 19
			 years of age, claims must be filed using modifiers EP and TJ. When filing paper
			 claims, use type of service 6 with the modifiers.
2. ForARKids First-B beneficiaries, use
			 modifier TJ. When filing paper claims, use type of service 1 with the
			 modifier.
3. For individuals ages
			 19 and older, no modifier is necessary and type of service 1 must be used when
			 filing paper claims.
C.
			 Effective for dates of service on and after October 1, 2005, procedure code
90660,
influenza virus vaccine, live, for intranasal use, is
			 covered. Coverage is limited to healthy individuals ages 5 through 49 who are
			 not pregnant.
1. When filing claims for
			 children 5 throughl 8 years of age, use modifiers EP and TJ. When filing paper
			 claims, use type of service 6 with the modifiers.
2. ForARKids First-B beneficiaries, the
			 procedure code must be billed using modifier TJ. When filing paper claims, use
			 type of service 1 with the modifier.
3. No modifier is required for filing claims
			 for beneficiaries ages 19 through 49. Paper claims require type of service
1.
D.
			 Procedure code
90657,
influenza virus vaccine, split virus, for
			 children ages 6 through 35 months, is covered. Modifiers EP and TJ are
			 required. Paper claims require type of service 6 with the modifiers.
ForARKids First-B beneficiaries, use modifier TJ. When paper
				claims are filed, use type of service 1 with the modifier.
E. Procedure code
90658,
influenza virus vaccine, split virus, for use in individuals ages 3
			 years and older, will continue to be covered.
1. When filing paper claims for individuals
			 under age 19, use type of service 6 with modifiers EP and TJ.
2. For ARKids First-B beneficiaries, use
			 modifier TJ. For paper claims, use type of service 1 with the
			 modifier.
3. No modifier is
			 required for filing claims for beneficiaries aged 19 and older. Use type of
			 service 1 when filing paper claims.