Arkansas Administrative Code
Agency 016 - DEPARTMENT OF HUMAN SERVICES
Division 06 - Medical Services
Rule 016.06.06-027 - Prosthetics Update #81 and Certified Nurse Midwife Update #74
Current through Register Vol. 49, No. 9, September, 2024
Section II Prosthetics
|
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 |
|
Day Care Facility |
5 |
52 |
|
Night Care Facility |
6 |
52 |
|
Nursing Facility |
7 |
32 |
|
Skilled Nursing Facility |
8 |
31 |
|
Ambulance |
9 |
41 |
|
Other Locations |
0 |
99 |
|
Independent Laboratory |
A |
81 |
|
Ambulatory Surgical Center |
B |
24 |
|
Residential Treatment Center |
C |
56 |
|
Specialized Treatment Facility |
D |
56 |
|
Comprehensive Outpatient Rehabilitative Facility |
E |
62 |
|
Independent Kidney Disease Treatment Center |
F |
65 |
|
Inpatient Psychiatric Facility |
G |
51 |
|
Type of Service (paper only) |
|
H-Over 21 |
|
U-Used Equipment |
|
I-Initial Rental |
|
6-Under 21 |
|
Modifiers |
|
EP- Service provided as part of EPSDT Program |
|
KH-Durable Medical Equipment (DME) item, initial claim, first month's rental |
|
NU-New Equipment |
|
RR-Durable Medical Equipment (DME) Rental |
|
U1-Medicaid Level of Care 1 (defined by state) |
|
U2-Medicaid level of Care 2 (defined by state) |
|
U3-Medicaid level of care 3 (defined by state) |
|
Modifiers |
|
U4-Medicaid level of care 4 (defined by state) |
|
U5-Medicaid level of care 5 (defined by state) |
|
UE-Used durable medical equipment (DME) |
|
52-Reduced Services |
Section II
Certified Nurse-Midwife
|
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 |
|
Nursing Facility |
7 |
32 |
|
Skilled Nursing Facility |
8 |
31 |
|
Other Locations |
0 |
99 |
|
Independent Laboratory |
A |
81 |
|
Ambulatory Surgical Center |
B |
24 |
|
Specialized Treatment Facility or Federally Qualified Health Center (FQHC) |
D |
56 |
|
Emergency Department for Emergency Services |
X |
23 |
|
Type of Service (paper only) |
|
9 - Certified Nurse- Midwife |
|
A - Family Planning |
