Arkansas Administrative Code
Agency 016 - DEPARTMENT OF HUMAN SERVICES
Division 06 - Medical Services
Rule 016.06.06-014 - 2006 National CPT and HCPCS Procedure Codes.

II. Non-Covered 2006 CPT Procedure Codes

III. Prior Authorization

The following 2006 CPT procedure codes require prior authorization (PA).01966

For procedure code 01966, the source for prior authorization is determined by the same criteria as deleted code 01964.

IV. Diagnosis Codes

Effective for dates of service on and after March 1, 2006, diagnosis codes in range 230.0 through 238.9 are also recognized as cancer diagnosis codes.

V. Special Billing Requirements

VI. Podiatry Program

The following procedure codes are payable to podiatry providers.

* These procedure codes require documentation to justify the procedure billed, except when the claim is for diagnosis codes 940.0 through 949.5.

VII. Certified Nurse-Midwife

VIII. Nurse Practitioner

IX. Oral Surgeon

X. Outpatient Hospital

Use procedure code 90765 for IV infusion therapy. For additional hours, sequential and/or concurrent infusions, bill revenue code 0760 (for observation), up to 8 hours maximum per day.

XI. Physician

Effective for dates of service on and after March 1, 2006, CPT procedure code 90799 is replaced by existing HCPCS procedure code T1502. HCPCS procedure code T1502 is to be used for "administration only" of IM and/or subcutaneous injections. Procedure code T1502 may be billed electronically or on paper. Use type of service "1" when filing paper claims. Procedure code T1502 must be billed when the drug is not supplied by the provider who administers the drug.

XII. Child Health Services (EPSDT

Effective for dates of service on and after March 1, 2006, CPT procedure code 90799 is replaced by existing HCPCS procedure code T1502. HCPCS procedure code T1502 is to be used for "administration only" of IM and/or subcutaneous injections. Procedure code T1502 may be billed electronically or on paper. Use type of service "6" when filing paper claims. Procedure code T1502 must be billed when the drug is not supplied by the provider who administers the drug.

XIII. Child Health Management Services (CHMS)

XIV. Rehabilitative Services for Persons with Mental Illness

XV. School-Based Mental Health (SBMH)

Effective for dates of service on and March 1, 2006, procedure code 96100 has been deleted and is non-payable. It is replaced by procedure code 96101. The modifiers listed below must be used with procedure code 96101 when filing claims for the SBMH services described.

XVI. Licensed Mental Health Practitioner (LMHP)

Effective for dates of service on and after March 1, 2006, procedure code 96100 has been deleted and is non-payable. It is replaced by procedure code 96101. The modifiers listed below must be used with procedure code 96101 when filing claims for the LMHP services described. This procedure is only payable to psychologists.

XVII. Rehabilitative Services for Youth and Children (RSYC)

Effective for dates of service on and after March 1, 2006, procedure code 96100 has been deleted and is non-payable. It is replaced by procedure code 96101. The modifiers listed below must be used with procedure code 96101 when filing claims for the RSYC services described.

XVIII. Additional Information

Complete descriptions of CPT 2006 procedure codes are in the CPT 2006 book. This book may be purchased from Ingenix online at http://www.ingenixonline.com/or by calling 1-800-464 -3649.

Thank you for your participation in the Arkansas Medicaid Program.

If you need this material in an alternative format, such as large print, please contact our Americans with Disabilities Act Coordinator at (501) 682-6789.

If you have questions regarding this notice, please contact the EDS Provider Assistance Center at In-State WATS 1-800-457 -4454, or locally and Out-of-State at (501) 376-2211.

Arkansas Medicaid provider manuals, official notices and remittance advice (RA) messages are available for downloading from the Arkansas Medicaid website: www.medicaid.state.ar.us.

Roy Jeffus, Director

I. General Information

A review of the 2006 HCPCS procedure codes has been completed and the Arkansas Medicaid Program will begin accepting updated HCPCS procedure codes on claims with dates of service on and after March 1, 2006.

II. 2006 HCPCS Payable Procedure Code Tables Information

Payable procedure codes have been broken into separate tables. Tables have been created for each affected provider type (e.g.: physician, hospital etc.).

The tables are designed with nine columns of information. All columns may not be applicable for each covered program, but have been devised for ease of reference.

The first column contains the HCPCS procedure code. In some instances, the procedure code will be shown in multiples, depending on the number of types of service (TOS) for which it can be used by a provider.

The second column contains the type of service (TOS) code that may be used in conjunction with the procedure code. TOS codes are used with procedure codes billed on paper. This information is provided when pertinent to billing protocol.

The third column shows procedure codes that require manual pricing and is titled Manually Priced Y/N. A letter "Y" in the column indicates that an item is manually priced and an "N" shows that an item is not manually priced. This information is provided when pertinent to billing protocol. Providers should consult their program manual to review the process involved in manual pricing.

The fourth and fifth columns indicate the beginning and ending range for diagnoses for which a procedure code may be used. (e.g.: 0530 through 0549). The information is used, for example, by physicians, hospitals and others.

The sixth column indicates the diagnosis list for which a procedure code may be used. This information is used, for example, by physicians, hospitals and other provider types. Applicable lists will be shown in each provider's section.

The seventh column indicates whether a procedure undergoes medical review before payment. The column is titled "Review Y/N". The letter "Y" in the column indicates that a review is necessary; and an "N" indicates that a review is not necessary. Providers should consult their program manual to obtain the information that is needed for a review.

The eighth column shows procedure codes that require prior authorization (PA) before the service may be provided. The column is titled "PA Y/N". The letter "Y" in the column indicates that a procedure code requires prior authorization and an "N" means the code does not require prior authorization. Providers should consult their program manual to ascertain what information should be provided for the prior authorization process.

The ninth column indicates any modifiers that must be used in conjunction with the procedure code, when billed, either electronically or on paper.

III. Diagnosis Range and Diagnosis Lists

Certain procedure codes are covered only when the primary diagnosis is covered within a diagnosis range or are on a diagnosis list.

Diagnosis List 003

ICD 9 Codes

042, 140.0 through 208.91

230.0 Through 238.9

Diagnosis List 027

ICD 9 Codes

20500, 20501, 20510, 20511, 20520, 20521, 20530, 20531, 20580, 20581,

20590, 20591, 2387

IV. HCPCS Procedure Codes Payable to Ambulatory Surgical Centers (ASC)

Please Note: Procedure code S2078 described as "Laparoscopic supracervical hysterectomy (subtotal hysterectomy), with or without removal of tubes(s), with or without removal of ovary(s)" is not covered by Arkansas Medicaid.

V. HCPCS Procedure Codes Payable to End Stage Renal Disease Providers (ESRD)

VI. HCPCS Procedure Codes Payable to Family Planning

* Family planning services require a family planning detail diagnosis code.

VII. HCPCS Procedure Codes Payable to Federally Qualified Health Centers (FQHC)

* Family planning services require a family planning detail diagnosis code.

VIII. HCPCS Procedure Codes Payable to Home Health

IX. HCPCS Procedure Codes Payable to Hospitals

The following information is related to procedure codes found in the hospital chart.

* Prior approval is required before services associated with the use of procedure codes A9542, A9543, A9544 and A9545 may be provided. To obtain prior approval, the provider must obtain a prior approval letter from the Arkansas Medicaid Medical Director and furnish the following documentation.

** Prior approval is required before services associated with the use of procedure code A9547 may be provided. To obtain prior approval, the provider must:

*** Prior approval is required for the service associated with the use of procedure code A9555. To obtain prior approval, the provider must:

# Protocol for galsulase (procedure code C9224) includes the following:

## Procedure code Q4079 requires review prior to payment.

IX. HCPCS Procedure Codes Payable to Hospitals

X. HCPCS Procedures Codes Payable to Independent Radiology

The following information is related to certain codes found within the independent radiology section below.

* Prior approval is required before services associated with the use of procedure codes A9542, A9543, A9544 and A9545 may be provided. To obtain prior approval, the provider must obtain a prior approval letter from the Arkansas Medicaid Medical Director and furnish the following documentation.

** Prior approval is required before services associated with the use of procedure code A9547 may be provided. To obtain prior approval, the provider must:

*** Prior approval is required for the service associated with the use of procedure code A9555. To obtain prior approval, the provider must:

XI. HCPCS Procedure Codes Payable to Nurse Midwives

Please Note: Bill T1502-U1 when the drug is not supplied by the provider who administers the drug.

XII. HCPCS Procedure Codes Payable to Nurse Practitioners

The following is information for procedure codes found in the chart below.

* Procedure code J7306 is covered for family planning. Family planning services require a family planning detail diagnosis code.

* Bill T1502 when the drug is not supplied by the provider who administers the drug.

XIII. HCPCS Procedure Codes Payable to Oral Surgeons

* Bill T1502 when the drug is not supplied by the provider who administers the drug.

XIV. HCPCS Procedure Codes Payable to Physicians and Area Health Care Education Centers (AHECs)

The following information is related to certain procedure codes found in the physician list.

* Prior approval is required before services associated with the use of procedure codes A9542, A9543, A9544 and A9545 may be provided. To obtain prior approval, the provider must obtain a prior approval letter from the Arkansas Medicaid Medical Director and furnish the following documentation.

** Prior approval is required before services associated with the use of procedure code A9547 may be provided. To obtain prior approval, the provider must:

*** Prior approval is required for the service associated with the use of procedure code A9555. To obtain prior approval, the provider must:

Please Note: Protocol for galsulase (procedure code J3490) includes the following:

## Procedure code Q4079 requires review prior to payment.

XV. HCPCS Procedure Codes Payable to Podiatrists

XVI. HCPCS Procedure Codes Payable to Private Duty Nursing

XVII. HCPCS Procedure Codes Payable to Prosthetics

XVIII. HCPCCS Procedure Codes Payable to Transportation

XIX. Miscellaneous Changes

Several previously payable HCPCS or local codes have been deleted in the 2006 HCPCS conversion. The table below lists the deleted HCPCS or local code, any replacement code and the program(s) affected.

The following procedure codes are new non-covered codes that replace previously non-covered codes.

XX. Non-Covered HCPCS Procedure Codes

The following procedure codes are not covered by Arkansas Medicaid.

Please Note: Procedure code S2078 described as "Laparoscopic supracervical hysterectomy (subtotal hysterectomy), with or without removal of tubes(s), with or without removal of ovary(s)" is not covered by Arkansas

XXI. Non-Covered HCPCS with Elements of CPT or Other Procedure Codes

The following 2005 HCPCS procedure codes are not payable because these services are covered by another CPT procedure code, another HCPCS procedure code or by a revenue code.

If you need this material in an alternative format, such as large print, please contact our Americans with Disabilities Act Coordinator at (501) 682-6789 or 1-877-708 -8191. Both telephone numbers are voice and TDD.

If you have questions regarding this transmittal, please contact the EDS Provider Assistance Center at 1-800-457 -4454 (Toll-Free) within Arkansas or locally and Out-of-State at (501) 376-2211.

Arkansas Medicaid provider manuals (including update transmittals), official notices and remittance advice (RA) messages are available for downloading from the Arkansas Medicaid website: www.medicaid.state.ar.us.

Thank you for your participation in the Arkansas Medicaid Program.

___________________________________________________

Roy Jeffus, Director