Arkansas Administrative Code
Agency 016 - DEPARTMENT OF HUMAN SERVICES
Division 06 - Medical Services
Rule 016.06.09-002 - Official Notice for the 2009 CPT Conversion & Official Notice for the 2009 HCPCS Conversion

I. General Information

A review of the 2009 CPT procedure codes has been completed, and the Arkansas Medicaid Program will begin accepting CPT 2009 procedure codes for dates of service on and after March 1,2009.

Procedure codes that are identified as deletions in CPT 2009 (Appendix B) are non-payable for dates of service on and after March 1, 2009.

For the benefit of those programs impacted by the conversions, the Arkansas Medicaid website fee schedule will be updated soon after the implementation of the 2009 CPT and HCPCS conversions.

II. Non-Covered 2009 CPT Procedure Codes

III. Prior Authorization

The following 2009 CPT procedure code requires prior authorization from the Arkansas Foundation for Medical Care (AFMC).

65756

IV. CPT 2009 Procedure Codes That Require A Paper Claim with Appropriate Attachments

96379

V. Newborn Care Services (Initial Screening)

The 2009 CPT procedure codes for newborn care are listed below. These procedure codes represent the initial newborn screening. This screening includes the physical exam of the baby and the conference(s) with newborn's parent(s) and is considered to be the initial newborn care/screen. Payment of these codes is considered a global rate and subsequent visits may not be billed in addition to codes 99460, 99461, and 99463.

Note the descriptions, modifiers, and required diagnosis range. The newborn care procedure codes require a modifier or modifiers and a primary detail diagnosis of V30.00-V37.21 for all providers. Refer to the appropriate manual(s) for additional information about newborn screenings.

VI. Existing Outpatient Procedure Codes:

Reimbursement of the following existing outpatient surgical procedure codes have been assigned to outpatient group IV.

VII Podiatry Program

VIII. Oral Surgeon Services

The following 2009 CPT procedure codes are payable to Oral Surgeons through the Physician program:

IX. Certified Nurse Midwife Program

The following 2009 CPT procedure codes are payable to Certified Nurse Midwives:

X. Nurse Practitioner Program

The following 2009 CPT procedure codes are payable to Nurse Practitioners:

XI. CPT Procedure Codes Payable to Ambulatory Surgical Centers

The following 2009 CPT procedure codes are payable to ambulatory surgical centers:

XII. Outpatient Hospitals

Use procedure code 96365 for IV therapy. For additional hours, sequential and/or concurrent infusions, bill revenue code 0760 (for observation), up to 8 hours maximum per day.

XIII. 2009 CPT Lab Procedure Codes with Diagnosis Restrictions

The following 2009 CPT procedure codes will be payable with a primary diagnosis as is Indicated below.

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 501-682-8323 (Local); 1-800-482 -5850, extension 2-8323 (Toil-Free) or to obtain access to these numbers through voice relay, 1-800-877 -8973 (TTY Hearing Impaired).

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 2009 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, 2009. Drug procedure codes require National Drug Code (NDC) billing protocol. Drug procedure codes that represent radiopharmaceuticals, vaccines, and allergen immunotherapy are exempt from the NDC billing protocol.

Procedure codes that are identified as deletions in 2009 HCPCS Level II will become non-payable for dates of service on and after March 1, 2009

II. 2009 HCPCS Payable Procedure Codes Tables Information

Procedure codes are in separate tables. Tables are created for each affected provider type (e.g.: prosthetics, home health etc.).

The tables of payable procedure codes for all affected programs are designed with nine columns of information. All columns may not be applicable for each covered program, but are devised for ease of reference.

III. Diagnosis Range and Diagnosis Lists

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

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

The following information is related to procedure codes found in the ASC table. For section IV, reference the superscript alpha character following the procedure code in the table to determine what coverage protocol listed below applies to that procedure code in the list. In addition to the special circumstances listed below with each alpha character, any other processes or requirements indicated in the table are also applicable.

A 04112,04113,04114

Each procedure code is manually reviewed and requires paper billing with an operative report attached that includes wound measurements.

V. HCPCS Procedure Codes Payable to Podiatrist

VI. HCPCS Procedure Codes Payable to Prosthetics

The following information is related to procedure codes found in the Prosthetics table.

Procedure codes in the table must be billed with appropriate modifiers. Modifier NU is indicated for beneficiaries 21 years of age and over. Modifier EP is indicated for beneficiaries under age 21 years of age.

For procedure codes that require a prior authorization, the written PA request must be obtained through the Utilization Review Section of the Division of Medical Services (DMS) for Wheelchairs and wheelchair related equipment and services. For other durable medical equipment, a written request must be submitted to the Arkansas Foundation for Medical Care. Please refer to your Arkansas Medicaid Prosthetics Provider Manual for details in requesting a DME prior authorization.

VII. HCPCS Procedure Codes Payable to Hospitals

The following information is related to procedure codes found in the hospital table. For section VII reference the superscript alpha character following the procedure code in the table to determine what coverage protocol listed below applies to that procedure code in the list. Claims that require attachments (such as op-reports and prior approval letters) must be billed on a paper claim. See Section II of this notice for information on requesting a prior approval letter. See Section III of this notice for diagnosis codes contained in diagnosis list 003, 029 and 030.

In addition to the special circumstances listed below with each alpha character, any other processes or requirements indicated in the table are also applicable.

VIII. HCPCS Procedures Codes Payable to Independent Lab

The following information is related to procedure codes found in the independent laboratory table.

IX. HCPCS Procedures Codes Payable to Independent Radiology

The following information is related to procedure codes found in the Independent Radiology table. This procedure requires a paper claim with a manufacturer's invoice identifying the cost of the radiopharmaceutical.

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

The following information is related to procedure codes found in the physicians and AHECs section ' table. For section X, reference the superscript alpha character following the procedure code in the table to determine what coverage protocol applies to that procedure code in the list. Claims that require attachments (such as operative reports and prior approval letters) must be billed on a paper claim. See section II of this notice for information on requesting a prior approval letter. See section

II I of this notice for diagnosis codes contained in diagnosis list 003, 029 and 030. In addition to the special circumstances listed below with each alpha character, any other processes or requirements indicated in the table are also applicable.

XI. HCPCS Procedure Codes Payable to Nurse Practitioners

XII. Non-Covered 2009 HCPCS with Elements of CPT or Other Procedure Codes

XIII. Non-Covered 2009 HCPCS Procedure Codes

The following procedure codes are not covered by Arkansas Medicaid.