Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 27 - Department of Medical Services › Rule 016.27.21-005 - Arkansas Medicaid Procedure Code Linking Table Project

Current through Register Vol. 49, No. 6, June, 2024
218.000
Authorization for
			 Services
2-1-22
All Adult Behavioral Health Services for Community Independence
				receiving Arkansas Medicaid healthcare benefits on a medical Spenddown basis
				are retrospectively reviewed for medical necessity.
View or print the procedure codes requiring retrospective
				review for authorization and for ABHSCI services.
240.100
Reimbursement
2-1-22
Reimbursement is based on the lesser of the billed amount or
				the Title XIX (Medicaid) maximum allowable for each procedure.
Reimbursement is contingent upon eligibility of both the
				beneficiary and provider at the time the service is provided and upon accurate
				completeness of the claim filed for the service. The provider is responsible
				for verifying that the beneficiary is eligible for Arkansas Medicaid prior to
				rendering services.
A. Outpatient
			 Services
Fifteen-Minute Units, unless otherwise stated
Adult Behavioral Health Services for Community Independence
				must be billed on a per unit basis as indicated in the service definition, as
				reflected in a daily total, per beneficiary, per service.
Time spent providing services for a single beneficiary may be
				accumulated during a single, 24-hour calendar day. Providers may accumulatively
				bill for a single date of service, per beneficiary, per Adult Behavioral Health
				Services for Community Independence service. Providers are not allowed to
				accumulatively bill for spanning dates of service.
All billing must reflect a daily total, per Adult Behavioral
				Health Services for Community Independence service, based on the established
				procedure codes. No rounding is allowed.
The sum of the days' time, in minutes, per service will
				determine how many units are allowed to be billed. That number must not be
				exceeded. The total of minutes per service must be compared to the following
				grid, which determines the number of units allowed.
15 Minute Units
Timeframe
One (1) unit =
8-24 minutes
Two (2) units =
25-39 minutes
Three (3) units =
40-49 minutes
Four (4) units =
50-60 minutes
60 minute Units
Timeframe
One (1) unit =
50-60 minutes
Two (2) units =
110-120 minutes
Three (3) units =
170-180 minutes
Four (4) units =
230-240 minutes
Five (5) units =
290-300 minutes
Six (6) units =
350-360 minutes
Seven (7) units=
410-420 minutes
Eight (8) units=
470-480 minutes
30 Minute Units
Timeframe
One (1) unit =
25-49 minutes
Two (2) units =
50-60 minutes
In a single claim transaction, a provider may bill only for
				service time accumulated within a single day for a single beneficiary. There is
				no "carryover" of time from one day to another or from one beneficiary to
				another.
Documentation in the beneficiary's record must reflect exactly
				how the number of units is determined.
No more than four (4) units may be billed for a single hour per
				beneficiary or provider of the service.
NOTE: For services provided by a Qualified Behavioral
				Health Provider (QBHP), the accumulated time for the Adult Behavioral Health
				Services for Community Independence program service, per date of service, is
				one total, regardless of the number of QBHPs seeing the beneficiary on that
				day. For example, two (2) QBHPs see the same beneficiary on the same date of
				service and provides Adult Life Skills Development. The first QBHP spends a
				total of 10 minutes with the beneficiary. Later in the day, another QBHP
				provides Adult Life Skills Development to the same beneficiary and spends a
				total of 15 minutes. A total of 25 minutes of Behavioral Assistance was
				provided, which equals (two) 2 allowable units of service. Only one QBHP may be
				shown on the claim as the performing provider.
View or print the procedure codes for ABHSCI
				services.