Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.06-045 - ARKids First-B Provider Manual Update Transmittal #38

Current through Register Vol. 49, No. 6, June, 2024
Section II ARKids First-B
SECTION II
ARKIDS FIRST - B
222.300
Dental Services Benefit Limit
Dental services for ARKids First-B participants are limited to
				one (1) initial oral exam, bite-wings, scalings and prophylaxis/fluoride
				treatments per state fiscal year (July 1-June 30). The procedure codes listed
				in the table below may be billed for the prophylaxis/fluoride.
Procedure Code
Description
D1110
Prophylaxis - adult (ages 10-20)
D1120
Prophylaxis - child (ages 0-9)
D1201
Topical application of fluoride (including prophylaxis)
						  - child (ages 0-9)
D1205
Topical application of fluoride (including prophylaxis)
						  - adult (ages 10-18)
Refer to Section
				II of the Dental Provider Manual
				for a complete listing of covered dental services.
Orthodontia Services
				are not covered for ARKids First-B participants.
Procedure codes for treatment services that are not shown as
				payable may be requested on treatment plans subject to review and approval by
				the Division of Medical Services dental consultants if such treatment is deemed
				medically necessary.
222.310
Preventive Dental Screens
A. Initial/Periodic Preventive Dental
			 Screens
Procedure code
D0120
must be billed for an
				initial/periodic preventive dental screening. ARKids First-B participants are
				limited to one (1) dental screen (initial oral exam) per state fiscal year
				(July 1-June 30).
B.
			 Interperiodic Preventive Dental Screens
ARKids First-B participants may receive interperiodic
				preventive dental screening. There is no limit on this service. However, prior
				authorization must be obtained in order to receive reimbursement. See Section
				240.200 for prior authorization
				information.
Procedure code
D0140
must be billed for an
				interperiodic preventive dental screen. This service requires prior
				authorization.
222.400
Vision Care Benefit Limit
One routine eye exam (refraction) every twelve months is
				covered for ARKids First-B participants.
Refer to Section
				II of the Visual Care Provider
				Manual for a complete listing of covered visual services.
262.130
Preventive Health Screening
			 Procedure Codes
There are two (2) preventive health screening procedure codes
				to be used when billing for this service for ARKids First-B
				participants.
A. ARKids First-B
			 Preventive Health Screening; Newborn
The initial ARKids First-B preventive health screen for
				newborns is similar to Routine Newborn Care in the Arkansas Medicaid Physician
				and Child Health Services (EPSDT) Programs.
For routine newborn care following a vaginal delivery of
				C-section, procedure codes
99431, 99432 or 99435
should be used
				one time to cover all newborn care visits by the attending physician. Payment
				of these codes is considered a global rate and subsequent visits may not be
				billed in addition to
99431, 99432 and 99435.
These codes include
				the physical exam of the baby and the conference(s) with the newborn's
				parent(s), and are considered to be the initial Health screening.
For illness care, e.g., neonatal jaundice, use procedure codes
99221 through 99223.
Do
not
bill
99431, 99432
				or 99435
in addition to these codes.
Bill the program for ARKids First-B Preventive Health Screening
99381-99385 or 99391-99395
for all subsequent preventive health
				screenings after the date of birth.
B.
99381- 99385 or 99391-99395
ARKids First-B Preventive Health Screening
A preventive health screening in the ARKids First-B Program is
				similar to an EPSDT screen in the Arkansas Medicaid Child Health Services
				(EPSDT) Program.
Providers may not bill ARKids First-B for CPT evaluation and
				management procedure codes in addition to procedure code
99381-99385 or
				99391-99395.
262.400
Billing Procedures for
			 Preventive Health Screens
ARKids First-B reimburses providers for preventive health
				screenings performed at the intervals recommended by the American Academy of
				Pediatrics.
References in this section indicate that ARKids First-B
				preventive health screenings are similar to Arkansas Medicaid Child Health
				Services (EPSDT) screens. However, please note these important
				distinctions:
A. File claims for
			 ARKids First-B preventive health screenings in the CMS-1500 (formerly
			 HCFA-1500) claim format. Do not use the DMS-694 claim format.
B. Use type of service (TOS) (paper only)
			 code 1 with ARKids First-B preventive health screening procedure
			 codes.