Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.16-001 - Notice of Rule Making 002-15 (CPT) and 003-15 (HCPCS) Conversion Notices

Current through Register Vol. 49, No. 6, June, 2024
I.
General Information
A review of the 2015 HCPCS procedure codes has been completed
				and the Arkansas Medicaid Program will begin accepting updated Healthcare
				Common Procedural Coding System Level II (HCPCS) procedure codes on claims with
				dates of service on and after December 18, 2015. Drug procedure codes require
				National Drug Code (NDC) billing protocol. Drug procedure codes that represent
				radiopharmaceuticals, vaccines and allergen immunotherapy are exempt from the
				NDC billing protocol.
Procedure codes that are identified as deletions in 2015 HCPCS
				Level II will become non-payable for dates of service on and after December 18,
				2015.
Please NOTE: The Arkansas Medicaid website fee schedules
				will be updated soon after the implementation of the 2015 CPT and HCPCS
				conversions.
II.
2015 HCPCS Payable Procedure Codes Tables
			 Information
Procedure codes are in separate tables. Tables are created for
				each affected provider type (i.e., prosthetics, home health, etc.).
The tables of payable procedure codes for all affected programs
				are designed with eight columns of information. All columns may not be
				applicable for each covered program, but are devised for ease of
				reference.
Please NOTE: An asterisk indicates that the procedure
				code requires a paper claim.
1.
			 The
first
column of the list contains the HCPCS
			 procedure codes. The procedure code may be on multiple lines on the table,
			 depending on the applicable modifier(s) based on the service
			 performed.
2. The
second
column indicates any modifiers that must be
			 used in conjunction with the procedure code, when billed, either electronically
			 or on paper.
3. The
third
column indicates that the coverage of the
			 procedure code is restricted based on the beneficiary's age in number of
			 years.
4. Certain procedure codes
			 are covered only when the primary diagnosis is covered within a specific ICD
			 diagnosis range. This information is used, for example, by physicians and
			 hospitals. The
fourth
column, for all affected
			 programs, indicates the beginning and ending range of ICD CM diagnoses for
			 which a procedure code may be used.
5. The
fifth
column
			 contains information about the diagnosis list for which a procedure code may be
			 used. (See Section V of this notice for more information about diagnosis range
			 and lists.)
6. The
sixth
column indicates whether a procedure is subject
			 to medical review before payment. The column is titled "Review." The word "Yes"
			 or "No" in the column indicates whether a review is necessary or not. Providers
			 should consult their program manual to obtain the information that is needed
			 for a review.
7. The
seventh
column shows procedure codes that require
			 prior authorization (PA) before the service may be provided. The column is
			 titled "PA." The word "Yes" or "No" in the column indicates if a procedure code
			 requires prior authorization. Providers should consult their program manual to
			 ascertain what information should be provided for the prior authorization
			 process.
8. The
eighth
column indicates a procedure code requires a
			 prior approval letter from the Arkansas Medicaid Medical Director for Clinical
			 Affairs for the Division of Medical Services. The word "Yes" or "No" in the
			 column indicates if a procedure code requires a prior approval
			 letter.