Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.07-019 - Prosthetics Update Transmittal #96, Physician/Independent Lab/CRNA/Radiation Therapy Center Update Transmittal #129, and ARKids First-B Update #58

Current through Register Vol. 49, No. 6, June, 2024
SECTION II
ARKIDS FIRST - B
262.000
ARKids First-B Billing Procedures
262.100
CPT and/or HCPCS Procedure
			 Codes
National codes must be used for both electronic and paper
				claims. Where only a local code is available, it can be used indefinitely, but
				it can be billed only on a paper claim.
262.110
Medical Supplies Procedure
			 Codes
The following medical supplies procedure codes may be billed by
				Medicaid-enrolled Home Health and Prosthetics providers for ARKids First-B
				participants.
A4206
A4221
A4222
A4253 U1
A4256
A4259 U2
A4265
A4310
A4311
A4312
A4313
A4314
A4315
A4316
A4320
A4322
A4326
A4327
A4328
A4330
A4338
A4340
A4344
A4346
A4348
A4351
A4352
A4354
A4355
A4356
A4357
A4358
A4359
A4361
A4362
A4364
A4367
A4369
A4371
A4397
A4398
A4399
A4400
A4402
A4404
A4405
A4406
A4450
A4452
A4455
A4558
A4561
A4562
A4623
A4624
A4625
A4626
A4628
A4629
A4772
A4927
A5051
A5052
A5053
A5054
A5055
A5061
A5062
A5063
A5071
A5072
A5073
A5081
A5082
A5093
A5102
A5105
A5112
A5113
A5114
A5120
A5121
A5122
A5126
A5131
A6154
A6234
A6241
A6242
A6248
A7520
B4086
E0776
Procedure Code
Required Modifier(s)
Description
A6257
-
Transparent film, each (16 square inches or
						  less)
A6258
-
Transparent film, each (more than 16, but less than 48
						  square inches)
A6259
-
Transparent film, each (more than 48 square
						  inches)
A6216 A6219 A6228
Gauze pads medicated or non-medicated, each (16 square
						  inches or less)
A6217 A6220 A6229 A6403
Gauze pads medicated or non-medicated, each (more than
						  16, but less than 48 square inches)
A6204 A6218 A6221 A6230
Gauze pads medicated or non-medicated, each (more than
						  48 square inches)
A6441 A6446
-
Gauze, non-elastic, per roll (1 linear
						  yard)
A6242 A6245
-
Hydrogel dressing, each (16 square inches or
						  less)
A6243 A6246
-
Hydrogel dressing, each (more than 16, but less than 48
						  square inches)
A6244 A6247
-
Hydrogel dressing, each (more than 48 square
						  inches)
A6248
-
Hydrogel dressing, each (1 ounce)
A6234 A6237
-
Hydrocolloid dressing, each (16 square inches or
						  less)
A6235 A6238
-
Hydrocolloid dressing, each (more than 16, but less
						  than 48 square inches)
A6238
U1
Hydrocolloid dressing, each (more than 48 square
						  inches)
A6196
-
Alginate dressing, each (16 square inches or
						  less)
A6197
-
Alginate dressing, each (more than 16, but less than 48
						  square inches)
A6198
-
Alginate dressing, each (more than 48 square
						  inches)
A6197
-
Alginate dressing, each (1 linear yard)
A6209 A6212
-
Foam dressing, each (16 square inches or
						  less)
A6210 A6213
-
Foam dressing, each (more than 16, but less than 48
						  square inches)
A6211
-
Foam dressing, each (more than 48 square
						  inches)
A6200 A6203
-
Composite dressing, each (16 square inches or
						  less)
A6201 A6204
-
Composite dressing, each (more than 16, but less than
						  48 square inches)
A6202 A6205
-
Composite dressing, each (more than 48 square
						  inches)
A4253
-
Blood glucose test or reagent strips for home blood
						  glucose monitor, per 50 strips
A4353
-
Urinary intermittent catheter with insertion
						  supplies
A4394
-
Ostomy deodorant, all types, per ounce
A4365
-
Adhesive remover wipes, any type, per 50
A4368
-
Ostomy filters, any type, each
A6449 A6452
-
Gauze elastic, all types, per roll (linear
						  yard)
A4483
-
Moisture exchange/agreer, disposable, for use with
						  invasive mech
B4100
-
Food thickener, administered orally, per
						  oz.
A6549*
-
Stocking (Jobst)
*NOTE: A4221, A4222 and A6549 must be prior authorized.
				Form AFMC-103 must be used for the request for prior authorization.
View or print form AFMC-103 and instructions for
				completion.
The costs of B4100 and A6549 are not subject to the $125
				medical supplies monthly benefit limit.
The following procedure code must be utilized when billing for
				Pedia-Pop. Reimbursement for this product is provider's cost plus ten percent.
				Pedia-Pop is only for oral consumption, and only in frozen form.
Z2487
Pedia-Pop
1 unit = 1 box
Maximum = 2 units per date of service
NOTE: Pedia-Pop must be billed on
				paper.
262.120
Durable Medical Equipment (DME) Procedure Codes
The following DME HCPCS procedure codes may be billed by
				Medicaid-enrolled prosthetics providers for ARKids First-B participants.
HCPCS code
Capped rental, purchase or rental
						  only
A4635
Purchase only
A4636
Purchase only
A4637
Purchase only
E0100
Purchase only
E0105
Purchase only
E0110
Purchase only
E0111
Purchase only
E0112
Purchase only
E0113
Purchase only
E0114
Purchase only
E0116
Purchase only
E0130
Purchase only
E0135
Purchase only
E0140
Purchase only
E0143
Purchase only
E0147
Purchase only
E0153
Purchase only
E0154
Purchase only
E0155
Purchase only
E0157
Purchase only
E0158
Purchase only
E0161
Purchase only
E0163
Purchase only
E0164
Purchase only
E0166
Purchase only
E0167
Purchase only
E0175
Purchase only
E0180
Purchase only
E0181
Capped rental
E0182
Purchase only
E0184
Purchase only
E0185
Purchase only
E0189
Purchase only
E0190
Purchase only
E0191
Purchase only
E2601 E2602
Capped rental
E0196
Purchase only
E0197
Purchase only
E0200
Capped rental
E0202
Rental only
E0205
Capped rental
E0217
Capped rental
E0225
Capped rental
E0235
Purchase only
E0236
Capped rental
E0238
Purchase only
E0239
Capped rental
E0249
Purchase only
E0250
Capped rental
E0255
Capped rental
E0260
Capped rental
E0271
Capped rental
E0272
Capped rental
E0273
Purchase only
E0275
Purchase only
E0276
Purchase only
E0280
Purchase only
E0325
Purchase only
E0326
Purchase only
E0424
Rental only
E0430
Rental only
E0435
Rental only
E0439
Rental only
E0443
Purchase only
E0444
Purchase only
E0480
Capped rental
E0560
Purchase only
E0565
Capped rental
E0570
Purchase only
E0575
Capped rental
E0585
Capped rental
E0600
Rental only
E0605
Purchase only
E0606
Capped rental
E0607 U1
Purchase only
E0630
Capped rental
E0650
Capped rental
E0667
Capped rental
E0668
Capped rental
E0691
Rental only
E0692
Rental only
E0693
Rental only
E0694
Rental only
E0720
Capped rental
E0730
Capped rental
E0740
Purchase only
E0745
Capped rental
E0747
Rental only
E0840
Purchase only
E0850
Purchase only
E0860
Purchase only
E0870
Purchase only
E0880
Purchase only
E0890
Purchase only
E0900
Purchase only
E0910
Capped rental
E0920
Capped rental
E0930
Capped rental
E0935
Capped rental
E0940
Capped rental
E0941
Capped rental
E0942
Purchase only
E0944
Purchase only
E0945
Purchase only
E0946
Purchase only
E0947
Purchase only
E0948
Purchase only
E1130
Capped rental
E1140
Capped rental
E1150
Capped rental
E1160
Capped rental
E1224
Capped rental
E1390
Rental only
E1391
Rental only
E2611
Purchase only
E2612
Purchase only
Procedure Code
Required Modifier
Description
Capped rental, purchase or rental
						  only
E1340
NU
Durable medical equipment repairs/parts only repairs
						  will not be approved for more than the allowed purchase price of new equipment.
						  (The manufacturer's invoice must be attached to the repair claim for all
						  parts.)
Manually priced
Z0428
Bill on paper
NU
Unlisted durable medical equipment, $500.00 and over.
						  (The manufacturer's invoice must be attached to the claim form.)
Manually priced
Z1825
Bill on paper
NU
Unlisted durable medical equipment, under $500.00. The
						  manufacturer's invoice must be attached to the claim form.)
E0779 E0779
RR
Ambulatory infusion device, payable only when services
						  are provided to patients receiving chemotherapy, pain management or antibiotic
						  treatment in the home
Rental only
A7034 A7034
RR
CPAP (continuous positive airway pressure) device,
						  nasal (includes necessary accessory items)
Note: Complete medical data
						  pertinent to the request must be submitted with a prior authorization
						  request.
Rental only
E0445
-
Pulse oximeter (including 4 disposable
						  probes)
Rental only
E1340
EP, U3
Unlisted repairs/wheelchairs
Manually priced
E0483
UB
High-frequency chest-wall oscillation
Rental only
E0483
RR
air-pulse generator system, incl
E0483
"
Pulmonary vest (The manufacturer's invoice must be
						  attached to the claim form.)
Purchase only
E1340
U4
Maintenance for capped rental items
N/A
E1340
NU, U1
Labor only (a maximum of twenty (20) units per date of
						  service is allowed) (20 units = 5 hours of labor)
Manually priced
E1340
"
Labor only (a maximum of twenty (20) units per date of
						  service is allowed) (20 units = 5 hours of labor)
Manually priced
A4670
-
Electronic blood pressure monitor and cuff
Rental only
A4230
-
Infusion set for external insulin pump, non-needle
						  cannula type
Purchase only
A4213
-
Syringes, sterile, 20 cc or greater, each
Purchase only
Bill on paper
-
Power kit/batteries
Purchase only
A6021 A6022 A6023 A6024
Polyskin dressing
Purchase only
A4627
UB
Spacer bag or reservoir, with or without mask, for use
						  with metered dose inhaler
Purchase only
A4627
-
Spacer bag or reservoir, with mask, for use with
						  metered inhaler
Purchase only
262.140
Speech-Language Pathology
			 Procedure Codes
Procedure Code
Required Modifier
Description
92506
Evaluation for Speech Therapy
92507
-
Individual Speech Session
92507
UB
Individual Speech Therapy by Speech Language Pathology
						  Assistant
92508
-
Group Speech Session
92508
UB
Group Speech Therapy by Speech Language Pathology
						  Assistant
262.200
National Place of Service
			 Codes
Refer to the appropriate Arkansas Medicaid Provider Manual for
				instructions.
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 claim format. Do
			 not use the DMS-694 claim format.
NOTE: Certified nurse-midwives are restricted to
				performing the preventive health screen, Newborn 99431, 99432 or 99435. They
				may not bill procedure codes 99381-99385 or
				99391-99395.
262.430
Vaccines for Children
			 Program
The Vaccines for Children (VFC) Program was established to
				generate awareness and access for childhood immunizations. These vaccines are
				available for ARKids First-B participants who are under the age of 19. To
				enroll in the VFC Program, contact the Division of Health. Providers may also
				obtain the vaccines to administer from the Division of Health.
View or
				print the Division of Health contact information.
Vaccines available through the VFC program are covered for
				ARKids First-B participants. The administration fee only is reimbursed. When
				filing claims for administering VFC vaccines, providers must use the CPT
				procedure code for the vaccine administered. Electronic and paper claims
				require the modifier TJ.
For information about vaccines covered through the VFC program,
				contact the Division of Health (see contact link above).