Arkansas Administrative Code
Agency 016 - DEPARTMENT OF HUMAN SERVICES
Division 06 - Medical Services
Rule 016.06.06-015 - Ambulatory Surgical Center Provider Manual Update Transmittal #66
Universal Citation: AR Admin Rules 016.06.06-015
Current through Register Vol. 49, No. 9, September, 2024
Section II Ambulatory Surgical Center
201.100
Ambulatory Surgical Centers
(ASCs) in States Not Bordering Arkansas
A. ASCs in states not bordering Arkansas are
called limited services providers because they may enroll in Arkansas Medicaid
only after they have treated an Arkansas Medicaid beneficiary and have a claim
to file, and because their enrollment automatically expires.
1. A non-bordering state ASC may send a claim
to Provider Enrollment and Provider Enrollment will forward by return mail a
provider manual and a provider application and contract. View
or print Provider Enrollment Unit Contact
information.
2.
Alternatively, a non-bordering state ASC may download the provider manual and
provider application materials from the Arkansas Medicaid website,
www.medicaid.state.ar.us, and then submit its application and claim to the
Medicaid Provider Enrollment Unit.
B. Limited services providers remain enrolled
for one year.
1. If a limited services
provider treats another Arkansas Medicaid beneficiary during its year of
enrollment and bills Medicaid, its enrollment may continue for one year past
the newer claim's last date of service, if the ASC keeps the provider file
current.
2. During its enrollment
period the provider may file any subsequent claims directly to EDS.
3. Limited services providers are strongly
encouraged to submit claims through the Arkansas Medicaid website because the
front-end processing of web-based claims ensures prompt adjudication and
facilitates reimbursement.
216.800
Verteporfin (Visudyne)
A. Arkansas Medicaid covers Verteporfin for
all ages for certain diagnoses and subject to certain conditions and
documentation requirements.
1. Coverage of
Verteporfin is separate from coverage of the injection procedure.
2. The injection procedure is covered as an
outpatient surgery (see section
242.146 for billing
requirements).
B. The
beneficiary's medical record in the provider's files must document an eye exam
recent enough to establish the patient's current visual acuity. See section
242.146 for billing
requirements.
C. The diagnosis must
be among the following.
1. Predominantly
classic subfoveal choroidal neovascularization due to age-related macular
degeneration
2. Pathologic
myopia
3. Presumed ocular
histoplasmosis
D. The
lesion size determination must be included in the documentation of the eye
exam.
E The eye or eyes to be
treated by Verteporfin administration must be identified, with current visual
acuity noted.
F. If previous
treatments with other modalities have been attempted, those attempts and
outcomes must be documented as well.
242.146
Verteporfin (Visudyne)
A. Medicaid reimburses outpatient hospitals
for Verteporfin (Visudyne), HCPCS procedure code J3396 when it is
furnished to Medicaid beneficiaries of any age With an appropriate diagnosis..
1. Reimbursement for Verteporfin is not
included in the reimbursement for the related surgical procedure;
2. Providers may bill Medicaid separate
charges for Verteporfin and the related surgical procedure.
B. Claims for Verteporfin
administration must include one of the following ICD-9-CM diagnosis codes.
|
115.02 |
115.12 |
115.92 |
360.21 |
362.50 |
362.52 |
C. Use
anatomical modifiers to identify the eye(s) being treated.
D.
J3396 may be billed
electronically or on a paper claim.
E. See section
216.800 for coverage
information
Disclaimer: These regulations may not be the most recent version. Arkansas may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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