Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.05-084 - Certified Nurse-Midwife Provider Manual Update Transmittal #66; Developmental Day Treatment Clinic Services (DDTCS) PRovider Manual Update Transmittal #67; Nurse Practitioner Provider Manual Update Transmittal #59; Physician?Independent Lab/CRNA/Radiation Therapy Center Provider Manual Update Transmittal #103

Current through Register Vol. 49, No. 6, June, 2024
272.430
Family Planning Services Program Procedure Codes
The following list includes Family Planning Services Program
				procedure codes payable to certified nurse-midwives. When filing paper claims
				for family planning services, certified nurse-midwives must use type of service
				code "
A
." Applicable modifiers must be used for both electronic
				and paper claims. All procedure codes in this table require a family planning
				diagnosis code in each claim detail.
Procedure Code
Required Modifier(s)
Description
A4260
FP
Norplant System (Complete Kit)
J1055
FP
Medroxyprogesterone Acetate for contraceptive
						  use
J7300
FP
Intrauterine Copper Contraceptive
J7302
FP
Levonorgestrel-Releasing Intrauterine Contraceptive
						  System
S0612*
FP, SB, UB
Annual Post-Sterilization Visit
11975
FP, SB
Implantation of Contraceptive Capsules
11976
FP, SB
Removal of Contraceptive Capsules
11977
FP, SB
Removal and Reinsertion of Contraceptive
						  Capsules
36415
FP
Collection of Venous Blood by Venipuncture
58300
FP, SB
Insertion of Intrauterine Device
58301
FP, SB
Removal of Intrauterine Device
99402
FP, SB
Basic Family Planning Visit
99401
FP, SB, UA
Periodic Family Planning Visit
* Women in the FP-W category (eligibility category 69) who have
				undergone sterilization are eligible only for this annual follow-up
				visit.
272.493
Obstetrical Care Without Delivery
Certified nurse-midwives must use procedure code
59425
with modifier
UA
to bill for one to three visits for
				antepartum care without delivery.
Procedure code
59425
with no modifier must be used
				by providers to bill for four to six visits for antepartum care without
				delivery.
Use procedure code
59426
for seven or more visits
				for antepartum care without delivery.
This procedure code enables certified nurse-midwives rendering
				care to the patient during the pregnancy, but not delivering the baby, to
				receive reimbursement for their services provided. Coverage for this service
				will include routine sugar and protein analysis. One unit equals one visit.
				Units of service billed with this procedure code will not be counted against
				the patient's office visit benefit limit.
Providers must enter the "from" and "through" dates of service
				on the CMS-1500 claim form and the number of units being billed. One visit
				equals one unit of service. Providers must submit the claim within 12 months of
				the first date of service.
For example:
An OB patient is seen by the
				certified nurse-midwife on 1-10-05, 2-10-05, 3-10-05, 4-10-05, 5-10-05 and
				6-10-05. The patient then moves and begins seeing another provider prior to the
				delivery. The certified nurse-midwife may submit a claim with dates of service
				shown as 1-10-05 through 6-10-05 and 6 units of service entered in the
				appropriate field. This claim must be received by EDS prior to 12 months from
				1-10-05 to fall within the 12-month filing deadline. The certified
				nurse-midwife must have on file the patient's medical record that reflects each
				date of service being billed.
272.495
Risk Management Services for Pregnancy
A certified nurse-midwife may provide the risk management
				services listed below if he or she employs the professional staff indicated in
				the service descriptions below. If a certified nurse-midwife does not choose to
				provide the risk management services but believes the patient would benefit
				from them, he or she may refer the patient to a clinic that offers risk
				management services for pregnancy. Each of the risk management services
				described in parts A through E has a limited number of units of service that
				may be furnished. Coverage of these risk management services is limited to a
				maximum of 32 cumulative units.
A.
			 Risk Assessment
A medical, nutritional and psychosocial assessment by the
				certified nurse-midwife or registered nurse to designate patients as high or
				low risk.
1. Medical assessment using
			 the Hollister Maternal/Newborn Record System or equivalent form to include:
a. Medical history
b. Menstrual history
c. Pregnancy history