Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.05-015 - Ventilator Update #50

Current through Register Vol. 49, No. 6, June, 2024
242.100
Ventilator Equipment and Supplies Procedure Codes
The following procedure codes must be used to bill for
				ventilator equipment and supplies:
Procedure Code
Modifier(s)
Description
PA Req'd
Max. Units
Capped Rental, Purchase or Rental Only
A4483
Nasal Prosthesis
No
N/A
Purchase
E02501
Hospital bed, fixed height, with any type side rails,
						  with mattress
Yes*
1 per day (1 day = 1 unit)
Capped Rental
E02551
Hospital bed, variable height, hi-lo, with any type
						  side rails, with mattress
Yes*
1 per day (1 day = 1 unit)
Capped Rental
E02601
Hospital bed, semi-electric (head and foot adjustment),
						  with any type side rails, without mattress
Yes*
1 per day (1 day = 1 unit)
Capped Rental
E04241
Stationary compressed gaseous oxygen system, rental;
						  includes container, contents, regulator flowmeter, humidifier, nebulizer,
						  cannula or mask, and tubing
Yes*
1 per day (1 day = 1 unit)
Rental Only
E04301
Portable gaseous oxygen system, purchase; includes
						  regulator, flowmeter, humidifier, cannula or mask, and tubing
Yes*
1 per day (1 day = 1 unit)
Rental Only
E04351
Portable liquid oxygen system, purchase; includes
						  portable container, supply reservoir, flowmeter, humidifier, contents gauge,
						  cannula or mask, tubing, and refill adapter
Yes*
1 per day (1 day = 1 unit)
Rental Only
E04391
Stationary liquid oxygen system, rental; includes
						  container, contents, regulator, flowmeter, humidifier, nebulizer, cannula or
						  mask, and tubing
Yes*
1 per day (1 day = 1 unit)
Rental Only
E0450
Positive Pressure Ventilator and Accessories (New
						  Equipment) - Includes circuits, humidifier, low-pressure alarm, back-up
						  emergency power, resuscitator bag, emergency call, 24 hours/day, 7 day/week
						  availability and in-service training (used with invasive interface, e.g.,
						  tracheostomy tube)
Yes
1 per day (1 day = 1 unit)
Rental Only
E04501
UB
Positive Pressure Ventilator Supplies -Includes suction
						  catheter kits, trach kits, trach tubes, sterile water and all respiratory care
						  supplies (used with invasive interface, e.g., tracheostomy tube)
Yes
1 per day (1 day = 1 unit)
Purchase
E0450
UE
Positive Pressure Ventilator and Accessories (Used
						  Equipment) - Includes circuits, humidifier, low pressure alarm, backup
						  emergency power, resuscitator bag, emergency call, 24 hours/day, 7 day/week
						  availability and in-service training (used with invasive interface, e.g.,
						  tracheostomy tube)
Yes
1 per day (1 day = 1 unit)
Rental Only
E0500
IPPB machine, all types, with built-in nebulization;
						  manual or automatic valves; internal or external power source
Yes
1 per day
Rental Only
E05701
Nebulizer, with compressor
Yes*
1 per day (1 day = 1 unit)
Purchase Only
E06001
Respiratory suction pump, home model, portable or
						  stationary, electric
No
1 per day (1 day = 1 unit)
Rental Only
E06001
U1
Suction pump, home model, portable (Used
						  Equipment)
Yes
1 per day (1 day = 1 unit)
Rental Only
E1390
Oxygen concentrator, single delivery port, capable of
						  delivering 85 percent or greater oxygen concentration at the prescribed flow
						  rate
Yes*
1 per day
Rental Only
G02372
EP, UA
Respiratory therapy services for ventilator-dependent
						  patients
Yes
Frequency of visits as prescribed
N/A
G02382
EP, UA
1 Code may only be
			 billed for a ventilator patient in his or her home. The code is not covered for
			 a ventilator patient in a nursing facility.
2 Bill only for type of service (TOS) 6.
* Prior authorization is not required when another insurance
				pays at least 50% of the Medicaid maximum allowable reimbursement
				amount.