Arkansas Administrative Code
Agency 016 - DEPARTMENT OF HUMAN SERVICES
Division 06 - Medical Services
Rule 016.06.06-077 - Hospital/Critical Access Hospital (CAH)/End Stage Renal Disease (ESRD) Provider Manual Update Transmittal #86
Current through Register Vol. 49, No. 9, September, 2024
Section II Hospital/Critical Access Hospital (CAH)/End Stage Renal Disease (ESRD)
|
Group I |
|||||||
|
10021 |
10022 |
10040 |
10060 |
10061 |
10080 |
10081 |
10120 |
|
10121 |
10140 |
10160 |
10180 |
11000 |
11004 |
11005 |
11010 |
|
11011 |
11012 |
11040 |
11041 |
11042 |
11043 |
11044 |
11055 |
|
11056 |
11057 |
11100 |
11200 |
11201 |
11300 |
11301 |
11302 |
|
11303 |
11305 |
11306 |
11307 |
11308 |
11310 |
11311 |
11312 |
|
11313 |
11400 |
11401 |
11402 |
11403 |
11404 |
11406 |
11420 |
|
11421 |
11422 |
11423 |
11424 |
11426 |
11441 |
11442 |
11443 |
|
11444 |
11446 |
11451 |
11462 |
11470 |
11600 |
11601 |
11602 |
|
11603 |
11604 |
11606 |
11620 |
11621 |
11622 |
11623 |
11624 |
|
11626 |
11640 |
11641 |
11642 |
11643 |
11644 |
11646 |
11719 |
|
11720 |
11721 |
11730 |
11732 |
11740 |
11750 |
11752 |
11755 |
|
11760 |
11762 |
11765 |
11770 |
11971 |
11980 |
11981 |
11982 |
|
11983 |
12001 |
12002 |
12004 |
12005 |
12011 |
12013 |
12014 |
|
12015 |
12020 |
12032 |
12037 |
12041 |
12042 |
12044 |
12051 |
|
12053 |
12054 |
12055 |
13100 |
13101 |
13121 |
13131 |
13150 |
|
13151 |
13160 |
14021 |
14040 |
14061 |
15100 |
15400 |
15770 |
|
15850 |
15851 |
15931 |
15940 |
17000 |
17003 |
17004 |
17106 |
|
17107 |
17108 |
17110 |
17111 |
17250 |
17260 |
17261 |
17262 |
|
17263 |
17264 |
17266 |
17270 |
17271 |
17272 |
17273 |
17274 |
|
17276 |
17280 |
17281 |
17282 |
17283 |
17284 |
17286 |
17304 |
|
17305 |
19000 |
19020 |
19030 |
19125 |
19126 |
19260 |
19271 |
|
19290 |
19350 |
20000 |
20005 |
20101 |
20102 |
20103 |
20150 |
|
20200 |
20205 |
20206 |
20220 |
20501 |
20520 |
20526 |
20550 |
|
20551 |
20552 |
20553 |
20600 |
20605 |
20610 |
20612 |
20650 |
|
20665 |
20670 |
20680 |
20693 |
20694 |
20912 |
20957 |
21015 |
|
21110 |
21137 |
21208 |
21235 |
21310 |
21315 |
21320 |
21325 |
|
21335 |
21336 |
21337 |
21400 |
21423 |
21440 |
21450 |
21451 |
|
21454 |
21470 |
21501 |
21550 |
21555 |
21557 |
21620 |
21685 |
|
21720 |
21742 |
21920 |
21925 |
21930 |
22800 |
22852 |
22900 |
|
23020 |
23030 |
23044 |
23065 |
23066 |
23075 |
23076 |
23170 |
|
23172 |
23330 |
23331 |
23350 |
23450 |
23465 |
23540 |
23545 |
|
23600 |
23605 |
23650 |
23655 |
23700 |
23930 |
24006 |
24065 |
|
24077 |
24101 |
24105 |
24134 |
24136 |
24145 |
24200 |
24201 |
|
24300 |
24341 |
24350 |
24351 |
24500 |
24505 |
24530 |
24535 |
|
24560 |
24565 |
24577 |
24582 |
24605 |
24620 |
24640 |
24655 |
|
24675 |
24925 |
25000 |
25001 |
25028 |
25065 |
25066 |
25075 |
|
25076 |
25110 |
25111 |
25112 |
25115 |
25116 |
25118 |
25145 |
|
25259 |
25260 |
25263 |
25265 |
25270 |
25272 |
25274 |
25290 |
|
25300 |
25492 |
25500 |
25505 |
25515 |
25520 |
25525 |
25526 |
|
25530 |
25535 |
25560 |
25565 |
25600 |
25605 |
25611 |
25620 |
|
25624 |
25630 |
25635 |
25660 |
25675 |
25680 |
25690 |
26010 |
|
26011 |
26020 |
26025 |
26030 |
26037 |
26040 |
26055 |
26060 |
|
26115 |
26116 |
26117 |
26123 |
26125 |
26130 |
26135 |
26145 |
|
26160 |
26180 |
26185 |
26235 |
26320 |
26340 |
26356 |
26357 |
|
26370 |
26418 |
26432 |
26440 |
26450 |
26455 |
26460 |
26530 |
|
26540 |
26545 |
26546 |
26548 |
26550 |
26560 |
26561 |
26562 |
|
26565 |
26567 |
26568 |
26600 |
26605 |
26607 |
26608 |
26615 |
|
26641 |
26645 |
26665 |
26670 |
26675 |
26705 |
26720 |
26725 |
|
26727 |
26735 |
26740 |
26742 |
26746 |
26755 |
26756 |
26765 |
|
26775 |
26776 |
26820 |
26841 |
26842 |
26843 |
26852 |
26861 |
|
26910 |
26951 |
26989 |
27000 |
27005 |
27006 |
27041 |
27060 |
|
27062 |
27087 |
27090 |
27093 |
27095 |
27096 |
27230 |
27232 |
|
27235 |
27236 |
27252 |
27257 |
27265 |
27266 |
27275 |
27301 |
|
27306 |
27307 |
27310 |
27327 |
27332 |
27340 |
27347 |
27355 |
|
27370 |
27372 |
27385 |
27407 |
27450 |
27455 |
27488 |
27501 |
|
27502 |
27503 |
27508 |
27509 |
27510 |
27511 |
27519 |
27520 |
|
27532 |
27536 |
27552 |
27560 |
27562 |
27570 |
27600 |
27602 |
|
27605 |
27606 |
27610 |
27613 |
27618 |
27635 |
27650 |
27658 |
|
27659 |
27664 |
27665 |
27704 |
27745 |
27752 |
27756 |
27762 |
|
27766 |
27780 |
27781 |
27786 |
27808 |
27810 |
27818 |
27824 |
|
27842 |
27860 |
27886 |
28001 |
28002 |
28008 |
28010 |
28011 |
|
28022 |
28024 |
28030 |
28043 |
28060 |
28070 |
28080 |
28090 |
|
28092 |
28100 |
28104 |
28110 |
28111 |
28112 |
28113 |
28116 |
|
28120 |
28124 |
28150 |
28153 |
28160 |
28190 |
28192 |
28200 |
|
28220 |
28230 |
28232 |
28234 |
28240 |
28270 |
28272 |
28280 |
|
28285 |
28286 |
28288 |
28289 |
28290 |
28292 |
28293 |
28294 |
|
28296 |
28297 |
28298 |
28300 |
28302 |
28304 |
28306 |
28308 |
|
28309 |
28310 |
28312 |
28313 |
28344 |
28345 |
28400 |
28405 |
|
28435 |
28476 |
28490 |
28496 |
28545 |
28575 |
28605 |
28740 |
|
28750 |
28755 |
28810 |
28820 |
28890 |
29010 |
29035 |
29065 |
|
29086 |
29105 |
29125 |
29131 |
29305 |
29345 |
29358 |
29365 |
|
29405 |
29445 |
29450 |
29515 |
29580 |
29700 |
29710 |
29805 |
|
29834 |
29835 |
29837 |
29838 |
29843 |
29870 |
29871 |
29874 |
|
29882 |
29900 |
30000 |
30020 |
30115 |
30124 |
30130 |
30300 |
|
30310 |
30462 |
30620 |
30801 |
30802 |
30901 |
30903 |
30905 |
|
31231 |
31505 |
31510 |
31511 |
31512 |
31513 |
31515 |
31525 |
|
31526 |
31527 |
31528 |
31529 |
31530 |
31531 |
31535 |
31536 |
|
31540 |
31541 |
31560 |
31561 |
31570 |
31571 |
31575 |
31576 |
|
31577 |
31578 |
31579 |
31612 |
31615 |
31622 |
31625 |
31628 |
|
31629 |
31630 |
31631 |
31635 |
31640 |
31641 |
31645 |
31646 |
|
31656 |
31700 |
31708 |
31710 |
31715 |
31717 |
31720 |
31730 |
|
31820 |
31830 |
32000 |
32002 |
32019 |
32020 |
32201 |
32400 |
|
32405 |
32662 |
33020 |
33215 |
33224 |
33226 |
33233 |
34101 |
|
35450 |
35875 |
36005 |
36010 |
36140 |
36216 |
36218 |
36260 |
|
36261 |
36262 |
36425 |
36430 |
36460 |
36511 |
36512 |
36513 |
|
36514 |
36515 |
36516 |
36522 |
36555 |
36556 |
36557 |
36558 |
|
36595 |
36596 |
36597 |
36598 |
36640 |
36800 |
36815 |
36830 |
|
36831 |
36833 |
36870 |
37195 |
37200 |
37202 |
37203 |
37607 |
|
37609 |
37620 |
38220 |
38221 |
38300 |
38305 |
38308 |
38500 |
|
38505 |
38520 |
38525 |
38562 |
38724 |
38790 |
38792 |
39010 |
|
40800 |
40801 |
40804 |
40805 |
40806 |
40810 |
40819 |
40820 |
|
41000 |
41005 |
41008 |
41010 |
41100 |
41105 |
41110 |
41112 |
|
41113 |
41115 |
41116 |
41250 |
41252 |
41520 |
41800 |
41805 |
|
41830 |
42104 |
42106 |
42107 |
42182 |
42210 |
42226 |
42235 |
|
42305 |
42310 |
42320 |
42330 |
42408 |
42409 |
42600 |
42650 |
|
42665 |
42700 |
42720 |
42725 |
42804 |
42806 |
42808 |
42809 |
|
42960 |
42961 |
42972 |
43045 |
43200 |
43201 |
43202 |
43204 |
|
43205 |
43215 |
43216 |
43217 |
43219 |
43220 |
43226 |
43227 |
|
43228 |
43231 |
43232 |
43234 |
43235 |
43236 |
43237 |
43238 |
|
43240 |
43241 |
43242 |
43244 |
43245 |
43247 |
43248 |
43250 |
|
43251 |
43255 |
43256 |
43258 |
43259 |
43260 |
43261 |
43269 |
|
43326 |
43450 |
43453 |
43456 |
43458 |
43600 |
43752 |
43870 |
|
44360 |
44361 |
44363 |
44364 |
44365 |
44366 |
44369 |
44372 |
|
44373 |
44376 |
44377 |
44378 |
44380 |
44382 |
44385 |
44388 |
|
44389 |
44390 |
44391 |
44392 |
44394 |
44500 |
44850 |
45005 |
|
45108 |
45150 |
45170 |
45190 |
45300 |
45303 |
45305 |
45307 |
|
45308 |
45309 |
45315 |
45321 |
45330 |
45331 |
45332 |
45333 |
|
45335 |
45337 |
45338 |
45339 |
45340 |
45341 |
45342 |
45355 |
|
45378 |
45379 |
45380 |
45381 |
45382 |
45383 |
45384 |
45385 |
|
45386 |
45900 |
45905 |
45910 |
45915 |
45990 |
46020 |
46030 |
|
46040 |
46045 |
46050 |
46060 |
46070 |
46080 |
46083 |
46200 |
|
46210 |
46211 |
46220 |
46221 |
46230 |
46270 |
46320 |
46505 |
|
46600 |
46604 |
46606 |
46608 |
46610 |
46611 |
46615 |
46705 |
|
46706 |
46900 |
46910 |
46922 |
46924 |
47100 |
47500 |
47505 |
|
48102 |
49021 |
49041 |
49061 |
49080 |
49081 |
49180 |
49250 |
|
49420 |
49421 |
49422 |
49423 |
49424 |
49425 |
49426 |
49427 |
|
49428 |
49429 |
50200 |
50390 |
50391 |
50392 |
50393 |
50394 |
|
50395 |
50396 |
50398 |
50551 |
50553 |
50561 |
50570 |
50572 |
|
50575 |
50576 |
50580 |
50605 |
50684 |
50690 |
50951 |
50953 |
|
50955 |
50957 |
50961 |
50970 |
50972 |
50974 |
50976 |
50980 |
|
51005 |
51010 |
51030 |
51040 |
51050 |
51065 |
51600 |
51605 |
|
51610 |
51701 |
51702 |
51703 |
51705 |
51710 |
51715 |
51720 |
|
51726 |
51741 |
51795 |
51797 |
51798 |
52000 |
52001 |
52005 |
|
52007 |
52010 |
52204 |
52214 |
52260 |
52265 |
52270 |
52275 |
|
52281 |
52285 |
52290 |
52301 |
52325 |
52327 |
52351 |
52352 |
|
52354 |
52355 |
53020 |
53025 |
53040 |
53215 |
53444 |
53600 |
|
53601 |
53605 |
53620 |
53621 |
53640 |
53660 |
53661 |
53665 |
|
54001 |
54015 |
54050 |
54055 |
54056 |
54057 |
54060 |
54100 |
|
54105 |
54150 |
54152 |
54160 |
54161 |
54162 |
54163 |
54164 |
|
54205 |
54220 |
54230 |
54231 |
54235 |
54324 |
54328 |
54332 |
|
54336 |
54430 |
54450 |
54505 |
54512 |
54820 |
55000 |
55120 |
|
55605 |
55700 |
55705 |
55720 |
56405 |
56420 |
56441 |
56501 |
|
56515 |
56605 |
56606 |
56620 |
56625 |
56700 |
56720 |
56820 |
|
56821 |
57020 |
57022 |
57023 |
57100 |
57130 |
57155 |
57400 |
|
57410 |
57415 |
57420 |
57421 |
57425 |
57452 |
57454 |
57455 |
|
57456 |
57460 |
57500 |
57505 |
57510 |
57511 |
57700 |
57800 |
|
58346 |
58800 |
58820 |
58823 |
59000 |
59001 |
59012 |
59020 |
|
59025 |
59070 |
59074 |
59076 |
59300 |
59320 |
59412 |
59871 |
|
60001 |
60100 |
61020 |
61026 |
61050 |
61070 |
61334 |
61524 |
|
62180 |
62230 |
62252 |
62256 |
62270 |
62272 |
62273 |
62280 |
|
62281 |
62284 |
62290 |
62291 |
62355 |
62362 |
62365 |
62367 |
|
62368 |
63688 |
63744 |
64400 |
64405 |
64408 |
64410 |
64413 |
|
64415 |
64416 |
64417 |
64420 |
64421 |
64425 |
64430 |
64446 |
|
64447 |
64448 |
64449 |
64450 |
64470 |
64475 |
64479 |
64483 |
|
64505 |
64508 |
64517 |
64520 |
64585 |
64595 |
64626 |
64640 |
|
64650 |
64653 |
64681 |
64716 |
64774 |
64776 |
64778 |
64782 |
|
64783 |
64788 |
64835 |
64856 |
65175 |
65205 |
65210 |
65220 |
|
65222 |
65235 |
65265 |
65272 |
65400 |
65410 |
65420 |
65426 |
|
65450 |
65800 |
65805 |
65815 |
65855 |
65860 |
65865 |
65870 |
|
65875 |
65880 |
66020 |
66030 |
66500 |
66505 |
66710 |
66720 |
|
66761 |
66770 |
66821 |
67105 |
67121 |
67141 |
67145 |
67208 |
|
67210 |
67216 |
67218 |
67220 |
67221 |
67227 |
67228 |
67345 |
|
67350 |
67415 |
67500 |
67505 |
67515 |
67700 |
67710 |
67715 |
|
67800 |
67801 |
67805 |
67808 |
67810 |
67820 |
67840 |
67875 |
|
67880 |
67901 |
67908 |
67909 |
67911 |
67912 |
67930 |
67938 |
|
67966 |
68020 |
68100 |
68110 |
68115 |
68130 |
68371 |
68440 |
|
68530 |
68700 |
68761 |
68801 |
68810 |
68811 |
68815 |
68840 |
|
69000 |
69005 |
69020 |
69100 |
69105 |
69110 |
69145 |
69200 |
|
69205 |
69210 |
69220 |
69420 |
69421 |
69424 |
69433 |
69436 |
|
69610 |
|
Group II |
|||||||
|
11450 |
11471 |
12006 |
12007 |
12017 |
12018 |
12031 |
12034 |
|
12036 |
12046 |
12047 |
12052 |
12056 |
12057 |
13132 |
15574 |
|
15734 |
15831 |
19328 |
19370 |
20100 |
20240 |
20525 |
20615 |
|
20660 |
20661 |
20662 |
20663 |
20692 |
20982 |
21026 |
21031 |
|
21077 |
21198 |
21199 |
21240 |
21282 |
21345 |
21355 |
21356 |
|
21360 |
21406 |
21445 |
21461 |
21480 |
21556 |
21615 |
21627 |
|
21700 |
21725 |
21740 |
21743 |
22840 |
22843 |
22849 |
22851 |
|
22855 |
23035 |
23120 |
23156 |
23174 |
23410 |
23455 |
23462 |
|
23470 |
23505 |
23615 |
23625 |
23665 |
23675 |
23929 |
23935 |
|
24000 |
24066 |
24075 |
24076 |
24138 |
24140 |
24147 |
24160 |
|
24164 |
24220 |
24305 |
24332 |
24400 |
24538 |
24566 |
24575 |
|
24576 |
25024 |
25025 |
25035 |
25040 |
25100 |
25119 |
25150 |
|
25151 |
25210 |
25246 |
25248 |
25275 |
25301 |
25332 |
25394 |
|
25415 |
25430 |
25447 |
25545 |
25651 |
25810 |
25820 |
25825 |
|
26034 |
26035 |
26045 |
26070 |
26075 |
26080 |
26210 |
26350 |
|
26410 |
26433 |
26437 |
26471 |
26474 |
26516 |
26517 |
26580 |
|
26587 |
26593 |
26596 |
26650 |
26676 |
26706 |
26850 |
26990 |
|
26991 |
26992 |
27048 |
27049 |
27065 |
27070 |
27075 |
27078 |
|
27086 |
27122 |
27146 |
27176 |
27194 |
27238 |
27240 |
27295 |
|
27303 |
27324 |
27328 |
27329 |
27331 |
27333 |
27334 |
27365 |
|
27380 |
27405 |
27409 |
27442 |
27443 |
27446 |
27466 |
27500 |
|
27517 |
27556 |
27580 |
27594 |
27603 |
27607 |
27614 |
27615 |
|
27619 |
27681 |
27685 |
27695 |
27698 |
27705 |
27715 |
27732 |
|
27734 |
27750 |
27784 |
27814 |
27822 |
27825 |
27829 |
27880 |
|
27884 |
28003 |
28005 |
28045 |
28108 |
28119 |
28193 |
28250 |
|
28406 |
28436 |
28445 |
28456 |
28475 |
28546 |
28606 |
28805 |
|
28825 |
29046 |
29325 |
29804 |
29819 |
29820 |
29823 |
29824 |
|
29825 |
29826 |
29830 |
29836 |
29844 |
29860 |
29861 |
29873 |
|
29875 |
29876 |
29877 |
29879 |
29880 |
29881 |
29883 |
29884 |
|
29885 |
29886 |
29887 |
29888 |
29889 |
29891 |
29893 |
29894 |
|
29895 |
29901 |
30100 |
30110 |
30117 |
30118 |
30320 |
30420 |
|
30545 |
30560 |
31000 |
31020 |
31030 |
31070 |
31233 |
31235 |
|
31237 |
31238 |
31239 |
31240 |
31254 |
31256 |
31267 |
31276 |
|
31320 |
31502 |
31545 |
31580 |
31600 |
31613 |
31614 |
31623 |
|
31624 |
31643 |
31755 |
32820 |
33201 |
33208 |
33212 |
33216 |
|
33246 |
33249 |
33282 |
34401 |
35190 |
35301 |
35473 |
35475 |
|
35840 |
35903 |
36011 |
36145 |
36246 |
36420 |
36475 |
36478 |
|
36481 |
36500 |
36550 |
36560 |
36561 |
36563 |
36565 |
36568 |
|
36569 |
36575 |
36580 |
36581 |
36589 |
36590 |
36818 |
36819 |
|
36820 |
36832 |
36861 |
37500 |
37618 |
37765 |
37766 |
38510 |
|
38550 |
38720 |
39502 |
40500 |
40812 |
40814 |
40816 |
40818 |
|
40831 |
40840 |
40842 |
40843 |
41108 |
41114 |
41806 |
41820 |
|
41826 |
41870 |
41874 |
42000 |
42120 |
42140 |
42180 |
42205 |
|
42215 |
42335 |
42340 |
42415 |
42440 |
42510 |
42810 |
42815 |
|
42860 |
42870 |
42892 |
42894 |
42900 |
42955 |
42962 |
42970 |
|
43239 |
43246 |
43257 |
43262 |
43263 |
43264 |
43268 |
43605 |
|
43610 |
43611 |
43640 |
43641 |
43750 |
43760 |
43761 |
43830 |
|
43832 |
44015 |
44310 |
44370 |
44379 |
44383 |
44397 |
44602 |
|
44604 |
44615 |
44620 |
44640 |
44650 |
44660 |
44680 |
44700 |
|
44800 |
44820 |
44900 |
44901 |
45020 |
45100 |
45116 |
45130 |
|
45160 |
45317 |
45327 |
45334 |
45345 |
45387 |
45391 |
45392 |
|
45541 |
46250 |
46255 |
46257 |
46258 |
46260 |
46261 |
46262 |
|
46275 |
46280 |
46285 |
46288 |
46614 |
46700 |
46730 |
46751 |
|
46917 |
46934 |
46935 |
46936 |
46937 |
46938 |
46940 |
46947 |
|
47000 |
47001 |
47010 |
47011 |
47015 |
47382 |
47511 |
47525 |
|
47556 |
47600 |
48510 |
48511 |
49000 |
49002 |
49010 |
49020 |
|
49040 |
49060 |
49062 |
49085 |
49200 |
49201 |
49215 |
49255 |
|
49500 |
49600 |
49605 |
49606 |
49610 |
49611 |
50021 |
50240 |
|
50382 |
50384 |
50387 |
50389 |
50405 |
50780 |
51500 |
51520 |
|
51530 |
51725 |
51762 |
51800 |
51820 |
51840 |
51841 |
51845 |
|
51860 |
51880 |
51920 |
51940 |
51980 |
52317 |
52334 |
52402 |
|
53000 |
53010 |
53500 |
54322 |
54344 |
54348 |
54400 |
54415 |
|
54520 |
54522 |
54670 |
54700 |
54830 |
55060 |
55110 |
55250 |
|
55873 |
56440 |
56810 |
57061 |
57065 |
57107 |
57135 |
57210 |
|
57220 |
57240 |
57250 |
57260 |
57335 |
57461 |
57820 |
58340 |
|
58345 |
58353 |
58356 |
58740 |
58805 |
58822 |
58825 |
59120 |
|
59121 |
59830 |
59870 |
60210 |
61055 |
61333 |
61458 |
61618 |
|
61626 |
62140 |
62220 |
62225 |
62258 |
62263 |
62264 |
62282 |
|
62287 |
62310 |
62311 |
62318 |
62319 |
63005 |
63030 |
63047 |
|
63272 |
63650 |
63741 |
63746 |
64510 |
64530 |
64600 |
64605 |
|
64610 |
64612 |
64613 |
64614 |
64620 |
64622 |
64630 |
64680 |
|
64820 |
65130 |
65270 |
65435 |
66711 |
67015 |
67025 |
67030 |
|
67031 |
67038 |
67112 |
67570 |
67835 |
67882 |
67935 |
67950 |
|
68320 |
68325 |
68326 |
68330 |
68360 |
68362 |
68420 |
68720 |
|
69140 |
69300 |
69320 |
69511 |
69540 |
69700 |
69801 |
|
Group III |
|||||||
|
11006 |
11440 |
11771 |
11772 |
11960 |
11970 |
12035 |
13120 |
|
13152 |
14000 |
14001 |
14020 |
14041 |
14060 |
14300 |
14350 |
|
15000 |
15050 |
15101 |
15120 |
15200 |
15201 |
15220 |
15240 |
|
15241 |
15260 |
15261 |
15576 |
15740 |
15760 |
15852 |
15920 |
|
15922 |
15933 |
15941 |
15944 |
15945 |
15946 |
15950 |
15951 |
|
15952 |
15953 |
15956 |
15958 |
19100 |
19101 |
19102 |
19103 |
|
19110 |
19112 |
19120 |
19160 |
19180 |
19200 |
19296 |
19318 |
|
19340 |
19357 |
20225 |
20245 |
20900 |
20910 |
20924 |
21010 |
|
21030 |
21040 |
21046 |
21048 |
21060 |
21196 |
21230 |
21280 |
|
21344 |
21390 |
21421 |
21432 |
21465 |
21485 |
21502 |
21510 |
|
21600 |
21610 |
23000 |
23180 |
23182 |
23184 |
23190 |
23195 |
|
23405 |
23406 |
23460 |
23485 |
23550 |
24110 |
24120 |
24130 |
|
24301 |
24310 |
24343 |
24344 |
24345 |
24346 |
24360 |
24430 |
|
24495 |
24587 |
24615 |
25085 |
25101 |
25105 |
25107 |
25120 |
|
25130 |
25135 |
25215 |
25230 |
25240 |
25280 |
25295 |
25315 |
|
25316 |
25337 |
25350 |
25355 |
25365 |
25400 |
25440 |
25446 |
|
25652 |
25671 |
25676 |
25685 |
25695 |
25931 |
26100 |
26105 |
|
26110 |
26170 |
26200 |
26205 |
26215 |
26230 |
26373 |
26390 |
|
26415 |
26442 |
26445 |
26476 |
26477 |
26478 |
26479 |
26518 |
|
26520 |
26525 |
26685 |
26686 |
26715 |
26785 |
27130 |
27140 |
|
27165 |
27178 |
27185 |
27256 |
27259 |
27418 |
27437 |
27447 |
|
27472 |
27475 |
27479 |
27485 |
27495 |
27506 |
27507 |
27530 |
|
27535 |
27540 |
27620 |
27630 |
27656 |
27675 |
27680 |
27686 |
|
27687 |
27700 |
27720 |
27724 |
27788 |
27826 |
27827 |
28050 |
|
28107 |
28114 |
28118 |
28122 |
28130 |
28140 |
28171 |
28173 |
|
28175 |
28208 |
28222 |
28225 |
28226 |
28238 |
28260 |
28261 |
|
28262 |
28264 |
28315 |
28340 |
28505 |
28525 |
28576 |
28666 |
|
28715 |
29840 |
29846 |
29848 |
29850 |
29851 |
29855 |
29856 |
|
29862 |
29863 |
29892 |
29897 |
29902 |
30125 |
31051 |
31200 |
|
31201 |
31205 |
31255 |
31287 |
31288 |
31290 |
31291 |
31292 |
|
31293 |
31294 |
31420 |
31546 |
31582 |
31636 |
31638 |
31785 |
|
31825 |
32200 |
32606 |
33120 |
33210 |
33218 |
33250 |
35458 |
|
35471 |
35761 |
36120 |
36217 |
36247 |
36566 |
36570 |
36571 |
|
36576 |
36578 |
36582 |
36583 |
36584 |
36585 |
36821 |
36825 |
|
36838 |
36860 |
37205 |
37207 |
38100 |
38204 |
38206 |
38207 |
|
38211 |
38212 |
38230 |
38242 |
38530 |
38542 |
38740 |
38745 |
|
38760 |
39503 |
40510 |
40520 |
40525 |
40527 |
40530 |
40650 |
|
40700 |
40844 |
41120 |
41251 |
41825 |
41827 |
42200 |
42220 |
|
42260 |
42500 |
43243 |
43620 |
43621 |
43622 |
43631 |
43632 |
|
43633 |
43634 |
43635 |
43820 |
43880 |
44050 |
44125 |
44314 |
|
44340 |
44603 |
44605 |
44625 |
44626 |
44661 |
44950 |
44960 |
|
45000 |
45110 |
45111 |
45112 |
45113 |
45114 |
45119 |
45120 |
|
45121 |
45123 |
45135 |
45320 |
45540 |
45550 |
46740 |
46946 |
|
47379 |
47605 |
49220 |
49329 |
49580 |
49900 |
50020 |
50080 |
|
50130 |
50234 |
50549 |
50783 |
50948 |
51045 |
51565 |
51865 |
|
51900 |
51925 |
51960 |
52224 |
52234 |
52235 |
52240 |
52250 |
|
52276 |
52277 |
52282 |
52283 |
52300 |
52305 |
52400 |
52500 |
|
53220 |
53230 |
53235 |
53240 |
53265 |
53275 |
54065 |
54110 |
|
54115 |
54120 |
54326 |
54416 |
54435 |
54530 |
54550 |
54560 |
|
54840 |
54860 |
54861 |
55040 |
55041 |
55150 |
55175 |
55180 |
|
55400 |
55500 |
55520 |
56740 |
57000 |
57010 |
57105 |
57287 |
|
57288 |
57520 |
57522 |
57530 |
57550 |
57720 |
58120 |
58140 |
|
58145 |
59160 |
59812 |
59820 |
59821 |
60200 |
60240 |
60270 |
|
60280 |
60281 |
60500 |
60521 |
61140 |
61305 |
61313 |
61314 |
|
61343 |
61750 |
61888 |
62000 |
62141 |
62143 |
62146 |
63056 |
|
63075 |
64702 |
64704 |
64708 |
64712 |
64713 |
64714 |
64718 |
|
64719 |
64721 |
64722 |
64726 |
64732 |
64734 |
64736 |
64738 |
|
64740 |
64742 |
64744 |
64772 |
64784 |
64786 |
64787 |
64790 |
|
64795 |
64821 |
64822 |
64823 |
64831 |
65135 |
65140 |
65150 |
|
65155 |
65275 |
65290 |
65850 |
66600 |
66605 |
66625 |
66630 |
|
66635 |
66762 |
67040 |
67101 |
67110 |
67320 |
67331 |
67332 |
|
67334 |
67335 |
67825 |
67830 |
67850 |
67902 |
67903 |
67904 |
|
67906 |
67914 |
67915 |
67916 |
67917 |
67921 |
67922 |
67923 |
|
67924 |
67961 |
67971 |
67973 |
67974 |
67975 |
68328 |
68500 |
|
68505 |
68510 |
68520 |
68705 |
|
Group IV |
|||||||
|
15040 |
15110 |
15115 |
15130 |
15135 |
15150 |
15155 |
15170 |
|
15175 |
15300 |
15320 |
15330 |
15335 |
15340 |
15360 |
15365 |
|
15420 |
15430 |
15572 |
15600 |
15610 |
15620 |
15630 |
15650 |
|
15738 |
15750 |
15840 |
15841 |
15842 |
15845 |
19140 |
19162 |
|
19182 |
19240 |
19298 |
19324 |
19325 |
19367 |
19368 |
19369 |
|
19380 |
20250 |
20251 |
20664 |
20690 |
20902 |
20920 |
20922 |
|
20926 |
20955 |
20962 |
20969 |
20970 |
20972 |
20973 |
21034 |
|
21044 |
21047 |
21049 |
21050 |
21100 |
21206 |
21210 |
21330 |
|
21338 |
21340 |
21343 |
21365 |
21366 |
21385 |
21386 |
21387 |
|
21407 |
21422 |
21452 |
21453 |
21462 |
21490 |
21495 |
22010 |
|
22015 |
22102 |
22210 |
22520 |
22521 |
22523 |
22524 |
22532 |
|
22533 |
22554 |
22558 |
22818 |
22819 |
22830 |
22850 |
23040 |
|
23100 |
23101 |
23107 |
23125 |
23130 |
23140 |
23150 |
23412 |
|
23415 |
23420 |
23466 |
23515 |
23616 |
23630 |
23660 |
23670 |
|
23680 |
24100 |
24102 |
24115 |
24116 |
24125 |
24126 |
24155 |
|
24320 |
24330 |
24331 |
24340 |
24342 |
24352 |
24354 |
24356 |
|
24420 |
24435 |
24470 |
24515 |
24516 |
24545 |
24546 |
24579 |
|
24586 |
24635 |
24665 |
24666 |
24685 |
25020 |
25023 |
25125 |
|
25126 |
25136 |
25310 |
25312 |
25320 |
25390 |
25391 |
25392 |
|
25393 |
25405 |
25450 |
25455 |
25574 |
25575 |
25628 |
25645 |
|
25670 |
25830 |
26121 |
26140 |
26250 |
26255 |
26261 |
26352 |
|
26358 |
26372 |
26392 |
26412 |
26416 |
26420 |
26426 |
26428 |
|
26434 |
26449 |
26480 |
26483 |
26485 |
26489 |
26490 |
26492 |
|
26494 |
26496 |
26497 |
26498 |
26499 |
26500 |
26502 |
26504 |
|
26508 |
26510 |
26531 |
26535 |
26536 |
26541 |
26542 |
26555 |
|
26844 |
26860 |
26862 |
26863 |
26952 |
27001 |
27003 |
27030 |
|
27033 |
27035 |
27040 |
27047 |
27052 |
27066 |
27071 |
27080 |
|
27110 |
27120 |
27158 |
27161 |
27170 |
27177 |
27187 |
27202 |
|
27253 |
27305 |
27315 |
27320 |
27330 |
27345 |
27350 |
27360 |
|
27390 |
27391 |
27392 |
27393 |
27394 |
27395 |
27396 |
27397 |
|
27400 |
27412 |
27415 |
27420 |
27422 |
27424 |
27425 |
27427 |
|
27428 |
27430 |
27435 |
27448 |
27457 |
27477 |
27496 |
27497 |
|
27513 |
27514 |
27524 |
27566 |
27612 |
27637 |
27638 |
27640 |
|
27641 |
27652 |
27654 |
27676 |
27690 |
27691 |
27692 |
27709 |
|
27758 |
27759 |
27792 |
27823 |
27828 |
27846 |
27848 |
27870 |
|
28035 |
28062 |
28072 |
28086 |
28088 |
28102 |
28103 |
28202 |
|
28210 |
28299 |
28305 |
28320 |
28322 |
28415 |
28420 |
28465 |
|
28485 |
28555 |
28585 |
28615 |
28636 |
28645 |
28675 |
28725 |
|
28735 |
28737 |
28760 |
29806 |
29807 |
29822 |
29827 |
29866 |
|
29867 |
29868 |
29898 |
29899 |
30140 |
30150 |
30160 |
30400 |
|
30410 |
30430 |
30435 |
30450 |
30460 |
30465 |
30520 |
30540 |
|
30580 |
30600 |
30630 |
30915 |
30920 |
31032 |
31588 |
32500 |
|
32503 |
32504 |
33206 |
33211 |
33213 |
33217 |
33240 |
33507 |
|
33548 |
33641 |
33820 |
33880 |
33881 |
33883 |
33886 |
33889 |
|
33891 |
33925 |
33926 |
34805 |
35206 |
35207 |
35456 |
35460 |
|
35472 |
35474 |
35476 |
35490 |
35510 |
35512 |
35522 |
35525 |
|
35647 |
35876 |
36014 |
36100 |
36200 |
36215 |
36245 |
36620 |
|
36810 |
37182 |
37183 |
37184 |
37187 |
37188 |
37201 |
37204 |
|
37215 |
37216 |
37700 |
37718 |
37722 |
37735 |
37760 |
37780 |
|
37785 |
38120 |
38555 |
38570 |
38571 |
38572 |
38700 |
39400 |
|
40654 |
40701 |
40720 |
40761 |
40845 |
42145 |
42225 |
42410 |
|
42420 |
42425 |
42426 |
42450 |
42505 |
42507 |
42508 |
42509 |
|
42820 |
42821 |
42825 |
42826 |
42830 |
42831 |
42835 |
42836 |
|
42950 |
43224 |
43249 |
43271 |
43280 |
43313 |
43314 |
43324 |
|
43520 |
43644 |
43645 |
43652 |
43653 |
43845 |
44005 |
44055 |
|
44120 |
44126 |
44127 |
44137 |
44180 |
44186 |
44187 |
44188 |
|
44204 |
44205 |
44206 |
44207 |
44208 |
44210 |
44211 |
44212 |
|
44227 |
44345 |
44346 |
44970 |
45136 |
45395 |
45397 |
45400 |
|
45402 |
45500 |
45505 |
45560 |
45562 |
45563 |
45800 |
45805 |
|
45820 |
45825 |
46710 |
46712 |
46715 |
46750 |
46753 |
46754 |
|
46760 |
46761 |
46762 |
47370 |
47371 |
47380 |
47381 |
47560 |
|
47561 |
47562 |
47563 |
47564 |
49320 |
49321 |
49322 |
49323 |
|
49419 |
49491 |
49492 |
49495 |
49496 |
49501 |
49505 |
49507 |
|
49520 |
49521 |
49525 |
49540 |
49550 |
49553 |
49555 |
49557 |
|
49560 |
49561 |
49565 |
49566 |
49568 |
49570 |
49572 |
49582 |
|
49585 |
49587 |
49590 |
49650 |
49651 |
49904 |
50040 |
50205 |
|
50220 |
50225 |
50250 |
50400 |
50541 |
50542 |
50543 |
50562 |
|
50592 |
50740 |
50945 |
50947 |
51990 |
51992 |
52310 |
52315 |
|
52318 |
52320 |
52330 |
52332 |
52341 |
52342 |
52343 |
52344 |
|
52345 |
52346 |
52450 |
52510 |
52601 |
52606 |
52612 |
52614 |
|
52620 |
52630 |
52640 |
52648 |
52700 |
53400 |
53405 |
53410 |
|
53420 |
53425 |
53430 |
53431 |
53440 |
53446 |
53447 |
53448 |
|
53449 |
53450 |
53460 |
53502 |
53510 |
53515 |
53520 |
53850 |
|
53853 |
54125 |
54300 |
54304 |
54305 |
54312 |
54360 |
54380 |
|
54417 |
54440 |
54600 |
54640 |
54650 |
54680 |
54690 |
54692 |
|
55530 |
55535 |
55540 |
55550 |
55650 |
55680 |
55859 |
55866 |
|
56317 |
56362 |
57200 |
57268 |
57295 |
57300 |
57305 |
57307 |
|
57308 |
57310 |
57311 |
57320 |
57330 |
57513 |
57531 |
57540 |
|
57545 |
57555 |
57556 |
58146 |
58180 |
58260 |
58290 |
58291 |
|
58292 |
58293 |
58294 |
58545 |
58546 |
58550 |
58552 |
58553 |
|
58554 |
58555 |
58558 |
58559 |
58560 |
58561 |
58562 |
58563 |
|
58660 |
58661 |
58662 |
58672 |
58673 |
58700 |
58720 |
58900 |
|
58920 |
58925 |
58940 |
58953 |
58954 |
58956 |
59150 |
59151 |
|
59409 |
59414 |
59514 |
59612 |
59620 |
60212 |
60220 |
60225 |
|
60650 |
61154 |
61322 |
61500 |
61516 |
61537 |
61540 |
61552 |
|
61556 |
61566 |
61567 |
61623 |
61630 |
61635 |
61640 |
61793 |
|
61863 |
61867 |
61885 |
62100 |
62161 |
62162 |
62163 |
62164 |
|
62165 |
62223 |
62292 |
62350 |
62351 |
62360 |
62361 |
63017 |
|
63035 |
63042 |
63045 |
63050 |
63051 |
63081 |
63090 |
63101 |
|
63102 |
63200 |
63265 |
63685 |
64561 |
64573 |
64581 |
64727 |
|
64802 |
64832 |
64834 |
64836 |
64837 |
64840 |
64857 |
64872 |
|
64874 |
64876 |
64885 |
64886 |
64890 |
64891 |
64892 |
64893 |
|
64895 |
64896 |
64897 |
64898 |
64901 |
64902 |
64905 |
64907 |
|
65091 |
65093 |
65101 |
65103 |
65105 |
65110 |
65260 |
65280 |
|
65285 |
65286 |
65710 |
65730 |
65750 |
65755 |
65772 |
65775 |
|
65810 |
65820 |
65900 |
65920 |
65930 |
66130 |
66150 |
66155 |
|
66160 |
66165 |
66170 |
66172 |
66180 |
66185 |
66220 |
66225 |
|
66250 |
66680 |
66682 |
66820 |
66825 |
66830 |
66840 |
66850 |
|
66852 |
66920 |
66930 |
66940 |
66982 |
66983 |
66984 |
66985 |
|
66986 |
67005 |
67010 |
67027 |
67028 |
67036 |
67039 |
67107 |
|
67108 |
67120 |
67250 |
67255 |
67311 |
67312 |
67314 |
67316 |
|
67318 |
67340 |
67343 |
67400 |
67405 |
67412 |
67413 |
67414 |
|
67445 |
67550 |
67560 |
68540 |
68550 |
69150 |
69222 |
69310 |
|
69501 |
69502 |
69505 |
69604 |
69620 |
69631 |
69632 |
69633 |
|
69635 |
69636 |
69637 |
69641 |
69642 |
69643 |
69644 |
69645 |
|
69646 |
69650 |
69660 |
69661 |
69662 |
69666 |
69670 |
69676 |
|
69677 |
69714 |
69715 |
69717 |
69718 |
69720 |
69725 |
69740 |
|
69745 |
69805 |
69806 |
69930 |
As of the revised date of this section, December 1, 2006, the following CPT and HCPCS procedure codes (with exceptional circumstances pertaining to some) are not payable by the Arkansas Medicaid Program to hospitals, critical access hospitals and ESRD facilities.
|
Non-Payable CPT Procedure Codes |
|||||||
|
11900 |
11901 |
11920 |
11921 |
11922 |
11950 |
11951 |
11952 |
|
11954 |
11975 |
11976 |
11977 |
13102 |
13122 |
13133 |
13153 |
|
15001 |
15111 |
15116 |
15131 |
15136 |
15151 |
15152 |
15156 |
|
15157 |
15171 |
15176 |
15301 |
15321 |
15331 |
15336 |
15341 |
|
15361 |
15366 |
15401 |
15421 |
15431 |
15756 |
15757 |
15758 |
|
15775 |
15776 |
15780 |
15781 |
15782 |
15783 |
15786 |
15787 |
|
15788 |
15789 |
15790 |
15791 |
15792 |
15793 |
15810 |
15811 |
|
15819 |
15820 |
15821 |
15822 |
15823 |
15824 |
15825 |
15826 |
|
15828 |
15829 |
15832 |
15833 |
15834 |
15835 |
15836 |
15837 |
|
15838 |
15839 |
15876 |
15877 |
15878 |
15879 |
16036 |
17360 |
|
17380 |
19316 |
19396 |
20956 |
21497 |
22318 |
22319 |
22522 |
|
22525 |
22534 |
24149 |
26551 |
26553 |
26554 |
26556 |
27036 |
|
27193 |
27591 |
27881 |
28531 |
30930 |
31632 |
31633 |
32491 |
|
32850 |
32851 |
32852 |
32853 |
32854 |
32855 |
32856 |
32997 |
|
33140 |
33141 |
33225 |
33410 |
33508 |
33768 |
33884 |
33930 |
|
33933 |
33935 |
33940 |
33944 |
33945 |
33960 |
33961 |
34800 |
|
34802 |
34803 |
34804 |
34808 |
34812 |
34813 |
34820 |
34825 |
|
34826 |
34830 |
34831 |
34832 |
35500 |
35600 |
35682 |
35683 |
|
35685 |
35686 |
35697 |
35879 |
35881 |
36000 |
36415 |
36416 |
|
36468 |
36469 |
36540 |
36600 |
36823 |
37185 |
37186 |
37206 |
|
37250 |
37251 |
38240 |
38241 |
39560 |
39561 |
43265 |
43496 |
|
43770 |
43771 |
43772 |
43773 |
43774 |
43843 |
43886 |
43887 |
|
43888 |
44128 |
44132 |
44133 |
44135 |
44136 |
44203 |
44213 |
|
44701 |
44715 |
44720 |
44721 |
44979 |
45126 |
45520 |
46500 |
|
47133 |
47134 |
47135 |
47136 |
47140 |
47141 |
47142 |
47143 |
|
47144 |
47145 |
47146 |
47147 |
47570 |
48550 |
48551 |
48552 |
|
49906 |
50300 |
50323 |
50325 |
50327 |
50328 |
50329 |
50544 |
|
50545 |
50546 |
50547 |
50548 |
54401 |
54405 |
54406 |
54408 |
|
54410 |
54411 |
54660 |
55450 |
55970 |
55980 |
56805 |
57106 |
|
57109 |
57111 |
57112 |
57170 |
58110 |
58300 |
58301 |
58600 |
|
58605 |
58611 |
58615 |
58670 |
58671 |
58970 |
58974 |
58976 |
|
59050 |
59051 |
59072 |
59200 |
59400 |
59410 |
59425 |
59426 |
|
59430 |
59510 |
59515 |
59525 |
59866 |
61105 |
61517 |
61586 |
|
61641 |
61642 |
61697 |
61698 |
61864 |
61865 |
61868 |
61886 |
|
62148 |
62160 |
63043 |
63044 |
63048 |
63103 |
64472 |
64476 |
|
64480 |
64484 |
64623 |
64627 |
65125 |
65760 |
65771 |
65780 |
|
65781 |
65782 |
66990 |
67225 |
68340 |
69090 |
69667 |
69710 |
|
69711 |
69965 |
69990 |
70010 |
70015 |
70170 |
70332 |
70373 |
|
70390 |
71040 |
71060 |
71090 |
72240 |
72255 |
72265 |
72270 |
|
72275 |
72285 |
72295 |
73040 |
73085 |
73115 |
73525 |
73542 |
|
73580 |
74235 |
74320 |
74327 |
74328 |
74329 |
74330 |
74350 |
|
74355 |
74360 |
74363 |
74425 |
74430 |
74440 |
74445 |
74450 |
|
74455 |
74470 |
74475 |
74480 |
74740 |
74742 |
75600 |
75605 |
|
75606 |
75625 |
75630 |
75650 |
75658 |
75660 |
75662 |
75665 |
|
75671 |
75676 |
75680 |
75685 |
75705 |
75710 |
75716 |
75722 |
|
75724 |
75726 |
75731 |
75733 |
75736 |
75741 |
75743 |
75746 |
|
75756 |
75790 |
75801 |
75803 |
75805 |
75807 |
75809 |
75810 |
|
75820 |
75822 |
75825 |
75827 |
75831 |
75833 |
75840 |
75842 |
|
75860 |
75870 |
75872 |
75880 |
75891 |
75893 |
75894 |
75896 |
|
75956 |
75957 |
75958 |
75959 |
75960 |
75961 |
75970 |
75978 |
|
76000 |
76001 |
76080 |
76086 |
76088 |
76096 |
76140 |
76360 |
|
76930 |
76942 |
76945 |
76946 |
76948 |
76986 |
77261 |
77262 |
|
77263 |
77427 |
77431 |
77750 |
78268 |
78890 |
78891 |
79200 |
|
79300 |
79440 |
79999 |
80103 |
81020 |
83037 |
84061 |
87001 |
|
87003 |
87472 |
87477 |
87902 |
88000 |
88005 |
88007 |
88012 |
|
88014 |
88016 |
88020 |
88025 |
88027 |
88028 |
88029 |
88036 |
|
88037 |
88040 |
88045 |
88099 |
88141 |
88161 |
88173 |
88188 |
|
88189 |
88321 |
88323 |
88325 |
88329 |
88331 |
88332 |
89250 |
|
89251 |
89253 |
89254 |
89255 |
89258 |
89259 |
89260 |
89261 |
|
89264 |
89268 |
89272 |
89280 |
89281 |
89290 |
89291 |
89335 |
|
89342 |
89343 |
89344 |
89346 |
89352 |
89353 |
89354 |
89356 |
|
90378 |
90379 |
90384 |
90465 |
90466 |
90467 |
90468 |
90471 |
|
90472 |
90473 |
90474 |
90476 |
90477 |
90586 |
90648 |
90649 |
|
90657 |
90669 |
90680 |
90693 |
90723 |
90736 |
90760 |
90761 |
|
90766 |
90767 |
90768 |
90772 |
90774 |
90775 |
90801 |
90802 |
|
90804 |
90805 |
90806 |
90807 |
90816 |
90817 |
90818 |
90819 |
|
90845 |
90846 |
90847 |
90849 |
90853 |
90862 |
90875 |
90900 |
|
90901 |
90911 |
90918 |
90919 |
90920 |
90921 |
90997 |
91000 |
|
91030 |
91055 |
91060 |
91065 |
91100 |
92002 |
92004 |
92012 |
|
92014 |
92019 |
92020 |
92060 |
92065 |
92070 |
92081 |
92082 |
|
92083 |
92100 |
92140 |
92225 |
92226 |
92230 |
92283 |
92284 |
|
92285 |
92393 |
92504 |
92504 |
92511 |
92531 |
92532 |
92533 |
|
92534 |
92560 |
92590 |
92591 |
92592 |
92593 |
92594 |
92595 |
|
92596 |
92605 |
92606 |
92609 |
92950 |
92961 |
92970 |
92971 |
|
92973 |
92974 |
92975 |
92977 |
92984 |
93000 |
93010 |
93015 |
|
93018 |
93040 |
93042 |
93541 |
93542 |
93543 |
93544 |
93545 |
|
93701 |
93722 |
93727 |
93770 |
93784 |
93788 |
93790 |
93798 |
|
94452 |
94453 |
94656 |
94657 |
94660 |
94662 |
94667 |
94668 |
|
94762 |
95027 |
95056 |
95060 |
95065 |
95120 |
95125 |
95130 |
|
95131 |
95132 |
95133 |
95134 |
95145 |
95146 |
95147 |
95148 |
|
95149 |
95180 |
95250 |
95831 |
95832 |
95833 |
95834 |
95851 |
|
95852 |
96000 |
96001 |
96002 |
96003 |
96004 |
96150 |
96151 |
|
96152 |
96153 |
96154 |
96155 |
96549 |
96900 |
97010 |
97012 |
|
97014 |
97016 |
97022 |
97024 |
97026 |
97028 |
97032 |
97033 |
|
97034 |
97035 |
97036 |
97039 |
97112 |
97113 |
97116 |
97124 |
|
97139 |
97140 |
97150 |
97535 |
97537 |
97542 |
97545 |
97546 |
|
97755 |
97760 |
97761 |
98960 |
98961 |
98962 |
99000 |
99001 |
|
99024 |
99050 |
99051 |
99053 |
99058 |
99060 |
99082 |
99090 |
|
99150 |
99170 |
99172 |
99173 |
99175 |
99185 |
99190 |
99191 |
|
99192 |
99195 |
|
Non-Payable HCPCS Procedure Codes |
|||||||
|
A4220 |
A4262 |
A4263 |
A4270 |
A4290 |
A4300 |
A4301 |
A4305 |
|
A4306 |
A4321 |
A4649 |
A4651 |
A4652 |
A4653 |
A4657 |
A4660 |
|
A4663 |
A4670 |
A4671 |
A4672 |
A4673 |
A4674 |
A4706 |
A4707 |
|
A4708 |
A4709 |
A4714 |
A4719 |
A4720 |
A4721 |
A4722 |
A4723 |
|
A4724 |
A4725 |
A4726 |
A4728 |
A4730 |
A4736 |
A4737 |
A4740 |
|
A4750 |
A4755 |
A4760 |
A4765 |
A4766 |
A4770 |
A4771 |
A4772 |
|
A4773 |
A4774 |
A4802 |
A4860 |
A4870 |
A4890 |
A4911 |
A4913 |
|
A4918 |
A4927 |
A4928 |
A4929 |
A4930 |
A4931 |
A4932 |
A9150 |
|
A9270 |
A9546 |
A9566 |
A9698 |
A9700 |
C1178 |
C1300 |
C1713 |
|
C1714 |
C1715 |
C1716 |
C1717 |
C1718 |
C1719 |
C1720 |
C1721 |
|
C1722 |
C1724 |
C1725 |
C1726 |
C1727 |
C1728 |
C1729 |
C1730 |
|
C1731 |
C1732 |
C1733 |
C1750 |
C1751 |
C1752 |
C1753 |
C1754 |
|
C1755 |
C1756 |
C1757 |
C1758 |
C1759 |
C1760 |
C1762 |
C1763 |
|
C1764 |
C1765 |
C1766 |
C1767 |
C1768 |
C1769 |
C1770 |
C1771 |
|
C1772 |
C1773 |
C1776 |
C1777 |
C1778 |
C1779 |
C1780 |
C1781 |
|
C1782 |
C1783 |
C1784 |
C1785 |
C1786 |
C1787 |
C1788 |
C1789 |
|
C1813 |
C1814 |
C1815 |
C1816 |
C1817 |
C1818 |
C1819 |
C1874 |
|
C1875 |
C1876 |
C1877 |
C1878 |
C1879 |
C1880 |
C1881 |
C1882 |
|
C1883 |
C1884 |
C1885 |
C1887 |
C1888 |
C1891 |
C1892 |
C1893 |
|
C1894 |
C1895 |
C1896 |
C1897 |
C1898 |
C1899 |
C1900 |
C2614 |
|
C2615 |
C2616 |
C2617 |
C2618 |
C2619 |
C2620 |
C2621 |
C2622 |
|
C2625 |
C2626 |
C2627 |
C2628 |
C2629 |
C2630 |
C2631 |
C2632 |
|
C2633 |
C2634 |
C2635 |
C2636 |
C8900 |
C8901 |
C8902 |
C8903 |
|
C8904 |
C8905 |
C8906 |
C8907 |
C8908 |
C8909 |
C8910 |
C8911 |
|
C8912 |
C8913 |
C8914 |
C8918 |
C8919 |
C8920 |
C8950 |
C8951 |
|
C8952 |
C8953 |
C8954 |
C8955 |
C8956 |
C8957 |
C9003 |
C9113 |
|
C9121 |
C9220 |
C9221 |
C9222 |
C9399 |
C9716 |
C9723 |
C9724 |
|
C9725 |
E0305 |
E0500 |
E1500 |
E1510 |
E1530 |
E1540 |
E1550 |
|
E1560 |
E1570 |
E1575 |
E1580 |
E1590 |
E1592 |
E1594 |
E1600 |
|
E1610 |
E1615 |
E1620 |
E1625 |
E1630 |
E1632 |
E1634 |
E1635 |
|
E1636 |
E1637 |
E1639 |
E1699 |
G0008 |
G0009 |
G0010 |
G0108 |
|
G0109 |
G0141 |
G0143 |
G0144 |
G0145 |
G0147 |
G0148 |
G0168 |
|
G0219 |
G0235 |
G0252 |
G0257 |
G0259 |
G0260 |
G0265 |
G0266 |
|
G0268 |
G0281 |
G0282 |
G0283 |
G0288 |
G0289 |
G0290 |
G0291 |
|
G0293 |
G0294 |
G0295 |
G0297 |
G0298 |
G0299 |
G0300 |
G0302 |
|
G0303 |
G0304 |
G0305 |
G0306 |
G0307 |
G0330 |
G0331 |
G0332 |
|
G0333 |
G0339 |
G0340 |
G0341 |
G0342 |
G0343 |
G0367 |
G0375 |
|
G0376 |
G0378 |
G0379 |
G3001 |
G9016 |
G9017 |
G9018 |
G9019 |
|
G9020 |
G9034 |
J0135 |
J0215 |
J0270 |
J0275 |
J0365 |
J0395 |
|
J0583 |
J0587 |
J1055 |
J1056 |
J1430 |
J1438 |
J1595 |
J1675 |
|
J1756 |
J2357 |
J2794 |
J2795 |
J2805 |
J2810 |
J2850 |
J2940 |
|
J2996 |
J3110 |
J3355 |
J3411 |
J3415 |
J3471 |
J3472 |
J3486 |
|
J3530 |
J3535 |
J3570 |
J7030 |
J7040 |
J7042 |
J7060 |
J7070 |
|
J7100 |
J7110 |
J7130 |
J7300 |
J7302 |
J7317 |
J7500 |
J7620 |
|
J7627 |
J7640 |
J8498 |
J8499 |
J8501 |
J8510 |
J8515 |
J8520 |
|
J8521 |
J8540 |
J8560 |
J8565 |
J8597 |
J8600 |
J8610 |
J8700 |
|
J8999 |
J9160 |
J9175 |
J9395 |
L8609 |
P9051 |
P9052 |
P9053 |
|
P9054 |
P9055 |
P9056 |
P9057 |
P9058 |
P9059 |
P9060 |
Q0163 |
|
Q0164 |
Q0165 |
Q0166 |
Q0167 |
Q0168 |
Q0169 |
Q0170 |
Q0171 |
|
Q0172 |
Q0173 |
Q0174 |
Q0175 |
Q0176 |
Q0177 |
Q0178 |
Q0179 |
|
Q0180 |
Q0181 |
Q0480 |
Q0481 |
Q0482 |
Q0483 |
Q0484 |
Q0485 |
|
Q0486 |
Q0487 |
Q0488 |
Q0489 |
Q0490 |
Q0491 |
Q0492 |
Q0493 |
|
Q0494 |
Q0495 |
Q0496 |
Q0497 |
Q0498 |
Q0499 |
Q0500 |
Q0501 |
|
Q0502 |
Q0503 |
Q0504 |
Q0505 |
Q2004 |
Q3001 |
Q9945 |
Q9946 |
|
Q9947 |
Q9948 |
Q9949 |
Q9950 |
Q9951 |
Q9952 |
Q9953 |
Q9954 |
|
Q9955 |
Q9956 |
Q9957 |
Q9958 |
Q9959 |
Q9960 |
Q9961 |
Q9962 |
|
Q9963 |
Q9964 |
S0012 |
S0014 |
S0088 |
S0090 |
S0091 |
S0104 |
|
S0106 |
S0109 |
S0116 |
S0117 |
S0122 |
S0126 |
S0128 |
S0132 |
|
S0133 |
S0136 |
S0137 |
S0138 |
S0139 |
S0140 |
S0141 |
S0155 |
|
S0156 |
S0157 |
S0160 |
S0161 |
S0162 |
S0166 |
S0167 |
S0170 |
|
S0172 |
S0174 |
S0175 |
S0176 |
S0178 |
S0181 |
S0182 |
S0183 |
|
S0189 |
S0190 |
S0191 |
S0194 |
S0195 |
S0196 |
S0197 |
S0198 |
|
S0199 |
S0201 |
S0265 |
S0340 |
S0341 |
S0342 |
S0400 |
S0601 |
|
S0605 |
S0625 |
S0800 |
S0810 |
S0812 |
S2053 |
S2054 |
S2055 |
|
S2060 |
S2061 |
S2065 |
S2070 |
S2075 |
S2076 |
S2077 |
S2078 |
|
S2079 |
S2080 |
S2083 |
S2095 |
S2102 |
S2103 |
S2114 |
S2117 |
|
S2120 |
S2135 |
S2140 |
S2142 |
S2150 |
S2152 |
S2205 |
S2206 |
|
S2207 |
S2208 |
S2209 |
S2213 |
S2225 |
S2230 |
S2235 |
S2250 |
|
S2260 |
S2262 |
S2265 |
S2266 |
S2267 |
S2300 |
S2340 |
S2341 |
|
S2360 |
S2362 |
S2363 |
S2900 |
S3000 |
S3600 |
S3601 |
S3625 |
|
S3626 |
S3630 |
S3645 |
S3650 |
S3652 |
S3655 |
S3708 |
S3818 |
|
S3819 |
S3820 |
S3822 |
S3823 |
S3828 |
S3829 |
S3830 |
S3833 |
|
S3834 |
S3841 |
S3845 |
S3852 |
S3854 |
S3890 |
S3900 |
S3902 |
|
S4005 |
S4011 |
S4013 |
S4014 |
S4015 |
S4016 |
S4017 |
S4018 |
|
S4020 |
S4021 |
S4022 |
S4023 |
S4025 |
S4026 |
S4027 |
S4028 |
|
S4030 |
S4031 |
S4035 |
S4036 |
S4037 |
S4040 |
S4990 |
S4991 |
|
S4995 |
S5000 |
S5001 |
S5010 |
S5011 |
S5012 |
S5013 |
S5014 |
|
S5550 |
S5551 |
S5552 |
S5553 |
S5560 |
S5561 |
S5565 |
S5566 |
|
S5570 |
S5571 |
S8035 |
S8040 |
S8042 |
S8080 |
S8085 |
S8092 |
|
S8093 |
S8948 |
S8990 |
S9022 |
S9025 |
S9034 |
S9055 |
S9075 |
|
S9083 |
S9088 |
S9090 |
S9092 |
S9117 |
S9128 |
S9140 |
S9141 |
|
S9145 |
S9335 |
S9430 |
S9436 |
S9437 |
S9438 |
S9439 |
S9441 |
|
S9442 |
S9443 |
S9444 |
S9445 |
S9446 |
S9447 |
S9449 |
S9451 |
|
S9452 |
S9453 |
S9454 |
S9455 |
S9460 |
S9465 |
S9472 |
S9473 |
|
S9474 |
S9529 |
S9970 |
S9981 |
S9982 |
S9986 |
S9989 |
S9990 |
|
S9991 |
S9994 |
S9996 |
S9999 |
V5362 |
V5363 |
V5364 |
