Arkansas Administrative Code
Agency 016 - DEPARTMENT OF HUMAN SERVICES
Division 06 - Medical Services
Rule 016.06.06-020 - Chiropractic Provider Manual Update Transmittal #61; Dental Provider Manual Update Transmittal #82; ElderChoices Provider Manual Update Transmittal #60; Federally Qualified Health Center Provider Manual Update Transmittal #55; Nurse Practitioner Provider Manual Update Transmittal #62; Physician/CRNA/Independent Lab/Radiation Therapy Center Provider Manual Update Transmittal #108; Podiatrist Provider Manual Update Transmittal #63; Portable X-Ray Provider Manual Update Transmittal #52; Rehabilitative Services for Persons with Mental Illness Provider Manual Update Transmittal #65
Current through Register Vol. 49, No. 9, September, 2024
SECTION II Rehabilitative Services for Persons with Mental Illness
|
Place of Service |
Paper Claims |
Electronic Claims |
|
Outpatient Hospital |
2 |
22 |
|
Office |
3 |
11 |
|
Patient's Home |
4 |
12 |
|
Nursing Facility |
7 |
32 |
|
Skilled Nursing Facility |
8 |
31 |
|
Other Locations |
0 |
99 |
|
RSPMI Clinic (Telemedicine) |
H |
99 |
|
Emergency Services in ER |
X |
23 |
|
Type of Service |
|
|
R- |
RSPMI - (age 21 and older for services requiring PA) |
|
9- |
RSPMI - (under age 21 and adults age 21 and older for services not requiring PA) |
|
V- |
Telemedicine |
SUBJECT: Provider Manual Update Transmittal #61
SECTION II - CHIROPRACTIC
|
Place of Service |
Paper Claims |
Electronic Claims |
|
Doctor's Office |
3 |
11 |
|
Patient's Home |
4 |
12 |
|
Nursing Facility |
7 |
32 |
|
Skilled Nursing Facility |
8 |
31 |
|
Other Locations |
0 |
99 |
The type of service code for chiropractic services is 9.
SUBJECT: Provider Manual Update Transmittal #82
SECTION II - DENTAL
|
Place of Service |
Paper Claims |
Electronic Claims |
|
Inpatient Hospital |
1 |
21 |
|
Outpatient Hospital |
2 |
22 |
|
Emergency Room |
X |
23 |
|
Office/Clinic |
3 |
11 |
|
Nursing Facility |
7 |
32 |
|
Skilled Nursing Facility |
8 |
31 |
|
Other Location |
0 |
99 |
|
Ambulatory Surgical Center |
B |
24 |
|
Inpatient Psychiatric Facility |
G |
51 |
|
Type of Service Code |
Description |
|
K |
Dental |
|
1 |
Medical |
|
2 |
Surgical |
|
6 |
EPSDT Screen |
|
7 |
Anesthesia |
|
8 |
Assistant at Surgery (requires prior authorization) |
|
C, PorT |
Lab, X-Ray, Machine Test |
SUBJECT: Provider Manual Update Transmittal #60
SECTION II - ELDERCHOICES HOME & COMMUNITY-BASED (H&CB) 2176 WAIVER
The following procedure codes must be billed for ElderChoices Services:
|
Procedure Code |
Modifiers |
Description |
Unit of Service |
*POS for Paper Claims |
*POS for Electronic Claims |
|
S5100 |
" |
Adult Day Care, 6 to 8 hours per date of service |
15 min |
5 |
99 |
|
S5100 |
U1 |
Adult Day Care, 4 or 5 hours per date of service |
15 min |
5 |
99 |
|
S5100 |
TD |
Adult Day Health Care, 6 to 8 hours per date of service |
15 min |
5 |
99 |
|
S5100 |
TD, U1 |
Adult Day Health Care, 4 or 5 hours per date of service |
15 min |
5 |
99 |
|
S5120 |
- |
Chore Services |
15 min |
4 |
12 |
|
S5130 |
- |
Homemaker Services |
15 min |
4 |
12 |
|
S5135 |
- |
Respite Care - Short-Term Facility-Based |
15 min |
5,1,7 |
99,21,32 |
|
S5140 |
- |
Adult Foster Care |
1 day |
0 |
99 |
|
S5150 |
- |
Respite Care - In-Home |
15 min |
4 |
12 |
|
S5160 |
" |
Personal Emergency Response System -Installation |
One installation |
4 |
12 |
|
S5161 |
UA |
Personal Emergency Response System |
1 day |
4 |
12 |
|
S5170 |
- |
Frozen Home-Delivered Meal |
1 meal |
4 |
12 |
|
S5170 |
U1 |
Emergency Home Delivered Meals |
1 meal |
4 |
12 |
|
S5170 |
U2 |
Home-Delivered Meals |
1 meal |
4 |
12 |
|
T1005 |
- |
Respite Care - Long-Term Facility-Based |
15 min |
1 or 7 |
21,32,99 |
*Place of service code
|
Place of Service |
Paper Claims |
Electronic Claims |
|
Inpatient Hospital |
1 |
21 |
|
Patient's Home |
4 |
12 |
|
Day Care Facility |
5 |
99 |
|
Nursing Facility |
7 |
32 |
|
Other Locations |
0 |
99 |
The type of service code for ElderChoices services is 1.
SUBJECT: Provider Manual Update Transmittal #108
SECTION II - PHYSICIAN/INDEPENDENT LAB/CRNA/RADIATION THERAPY CENTER
|
Place of Service |
Paper Claims |
Electronic Claims |
|
Inpatient Hospital |
1 |
21 |
|
Outpatient Hospital |
2 |
22 |
|
Doctor's Office |
3 |
11 |
|
Patient's Home |
4 |
12 |
|
Ambulatory Surgical Center |
B |
24 |
|
Day Care Facility or DDTCS Facility |
5 |
99 |
|
Nursing Facility |
7 |
32 |
|
Skilled Nursing Facility |
8 |
31 |
|
Other Locations |
0 |
99 |
|
Independent Laboratory |
A |
81 |
|
End Stage Renal Disease Treatment Facility |
Ll_ |
65 |
|
Emergency Room |
X |
23 |
|
Inpatient Psychiatric Facility |
G |
51 |
|
Type of Service (TOS) |
TOS Code |
|
Family Planning |
A |
|
Telemedicine (evaluation and management services provided by physician at remote site) |
V |
|
Telemedicine (professional component of radiology procedure performed by physician at remote site |
W |
|
Telemedicine (technical component of X-ray or machine test transmitted from local to remote site |
Y |
|
Telemedicine (evaluation/management services of attending physician at local site, in consultation with physician at emote site) |
Z |
|
Medicine |
1 |
|
Surgery |
2 |
|
Anesthesia |
7 |
|
Assistant surgeon (requires prior authorization) |
8 |
Lab, machine test and X-ray TOS codes:
|
Description |
TOS Code |
|
Professional component |
P |
|
Technical component |
T |
|
Complete procedure |
C |
See Section 292.730 for definitions of P, T and C.
SUBJECT: Provider Manual Update Transmittal #55
SECTION II -FEDERALLY QUALIFIED HEALTH CENTER
|
Place of Service |
Paper Claims |
Electronic Claims |
|
Inpatient Hospital |
1 |
21 |
|
Outpatient Hospital |
2 |
22 |
|
Emergency Room - Hospital |
X |
23 |
|
Patient's Home |
4 |
12 |
|
Nursing Facility |
7 |
32 |
|
Skilled Nursing Facility |
8 |
31 |
|
Ambulance |
9 |
41 |
|
Other Locations |
0 |
99 |
|
Ambulatory Surgical Center |
B |
24 |
|
Federally Qualified Health Center (FQHC) |
D |
50 |
|
Inpatient Psychiatric Facility |
G |
51 |
|
Type of Service (TOS) |
TOS Code |
|
FQHC Encounter |
9 |
|
Telemedicine |
Y |
|
Surgery |
2 |
|
Family Planning |
A |
SUBJECT: Provider Manual Update Transmittal #62
SECTION II - NURSE PRACTITIONER
|
Place of Service |
Paper Claims |
Electronic Claims |
|
Inpatient Hospital |
1 |
21 |
|
Outpatient Hospital |
2 |
22 |
|
Office |
3 |
11 |
|
Patient's Home |
4 |
12 |
|
Day Care Facility |
5 |
99 |
|
Nursing Facility |
7 |
32 |
|
Skilled Nursing Facility |
8 |
31 |
|
Ambulance |
9 |
41 |
|
Other Locations |
0 |
99 |
|
Type of Service (TOS) |
TOS Code |
|
Family Planning |
A |
|
Nurse Practitioner |
N |
|
EPSDT |
6 |
SUBJECT: Provider Manual Update Transmittal #63
SUBJECT: Provider Manual Update Transmittal #63
SECTION II - PODIATRIST
|
Place of Service |
Paper Claims |
Electronic Claims |
|
Inpatient Hospital |
1 |
21 |
|
Outpatient Hospital |
2 |
22 |
|
Emergency Room |
X |
23 |
|
Doctor's Office |
3 |
11 |
|
Patient's Home |
4 |
12 |
|
Nursing Facility |
7 |
32 |
|
Skilled Nursing Facility |
8 |
31 |
|
Other Locations |
0 |
99 |
|
Ambulatory Surgical Center |
B |
24 |
|
Inpatient Psychiatric Facility |
G |
51 |
The type of service (TOS) code for podiatrist services is 4.
SUBJECT: Provider Manual Update Transmittal #52
SECTION II - PORTABLE X-RAY SERVICES
|
Place of Service |
Paper Claims |
Electronic Claims |
|
Patient's Home |
4 |
12 |
|
Nursing Facility |
7 |
32 |
|
Skilled Nursing Facility |
8 |
31 |
The type of service code (TOS) for portable X-ray services is T.
