Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.07-056 - Official Notice DMS-2007-A-4, DMS-2007-0-5, DMS-2007-X-2, DMS-2007-II-6, DMS-2007-L-6, DMS-2007-SS-2, DMS-2007-KK-5, DMS-2007-R-4 and DMS-2007-OO-5 - Family Planning Services

Current through Register Vol. 49, No. 6, June, 2024
I.
Background:
The Division of Medical Services issued an Official Notice
				(DMS-2006-A-4, DMS-2006-L-4, DMS- 2006-0-3, DMS-2006-KK-4, DMS-2006-X-1,
				DMS-2006-R-4, DMS-2006-II-4, DMS- 2006-00-3, DMS-2006-SS-3) dated June 20, 2006
				regarding family planning services, including additional procedure codes
				covered for the effective dates of service on or after February 1, 2006.
				However, at the time, the system was unable to process the claims for the
				specific procedure codes and providers were instructed to hold claims until
				further notice.
The purpose of this Official Notice is to notify providers of
				the previously added Family Planning Services and that the claims for these
				services may now be filed. This notice also addresses the billing procedures
				for those claims that were held and are now past the filing deadline, or will
				be past the filing deadline in the next 90 days. Claims past the filing
				deadline
must
be received by
January 31, 2008.
Any claims filed that are over two (2) years old after
January 31,
				2008,
will not be paid.
II.
Special
			 Instructions
Providers will have until January 31, 2008 to
				file claims that may be past the twelve (12) month filing deadline or claims
				for which the filing deadline will fall within this ninety (90) day window.
				Claims that are past the filing deadline must be submitted as a paper claim
to
the following address:
EDS/Research Analyst
P.O. Box 8036 Little Rock, AR 72203
NOTE: When submitting these claims that are past the
				filing deadline as described above, the provider must attach a memo indicating
				that the claims are impacted by
this
Family Planning Services
				Official Notice.
III.
Lab Procedure Codes
:
Effective for dates of service on or after February 1, 2006,
				Lab Procedure codes
87491
and
87591
are available as
				Family Planning procedure codes.
Professional claims for procedure codes
87491
and
87591
must include modifier
FP.
Whether a claim is
				paper or electronic, a family planning diagnosis code
must
be
				listed as primary on each detail.
Facilities billing for procedure codes
87491
and
87591
as family planning services
must
have a
				primary diagnosis of family planning on the claim, whether billed
				electronically or on paper.
IV.
Procedures Relating to
			 58565 "Hysteroscopy, surgical; with bilateral fallopian tube cannulation to
			 induce occlusion by placement of permanent implants"
			 (Essure):
A. Effective for
			 dates of service on and after
March 1, 2006,
professional claims
			 for conscious sedation (procedure codes
99144
and
99145)
may be covered as a family planning service only when administered in
			 conjunction with the Essure procedure
(58565).
NOTE: When 99144 and 99145 are billed for family
				planning, there must be a paid or pending professional claim for 58565 when
				billing for the same date of service.
1. To file claims for professional services,
			 use modifier
FP.
Whether billing electronically or on paper, the
			 primary detail diagnosis for each procedure must be a family planning diagnosis
			 code.
Claims for professional services that were provided in an
				outpatient hospital clinic should not include modifiers. Whether billing
				electronically or on paper, the primary detail diagnosis for each procedure
				must be a family planning diagnosis code.
2. Facility fees for
99144
and
99145
are included in the facility fee for
58565.