Arkansas Administrative Code
Agency 016 - DEPARTMENT OF HUMAN SERVICES
Division 06 - Medical Services
Rule 016.06.11-019 - Provider Manual Update Transmittal HOSPITAL-2-11
Current through Register Vol. 49, No. 9, September, 2024
Section II Hospital/Critical Access Hospital (CAH)/End Stage Renal Disease (ESRD)
The following table lists other services covered by Medicaid that are not restricted to the malignant neoplasm or HIV diagnoses:
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Radiation Therapy |
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National Code |
Required Modifier |
Local Code Description |
|
77417* |
U2 |
Localization/verification - Film 1 port |
|
77417* |
U3 |
Localization/verification - Film 2 port |
|
77417* |
U1 |
Localization/verification - Film 3 port |
|
77417* |
U2 |
Localization/verification - Film 4 port |
* Arkansas Medicaid Description
The following codes have special billing requirements for laboratory and X-ray procedures.
The following CPT and procedure codes will be payable with a primary diagnosis as is indicated below.
|
Procedure Code |
Required Primary Diagnosis |
|
83951 |
571.5 |
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88720 |
227.4, 774.2,774.6, or 782.4 |
|
88740 |
986 |
|
88741 |
289.7 or 791.2 |
|
Procedure Code |
Payment Method |
|
S3831 |
Manually priced with no age or diagnosis restrictions |
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S3835 |
|
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S3837 |
|
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S3840 |
|
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S3843 |
|
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S3844 |
|
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S3846 |
|
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S3847 |
|
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S3848 |
|
|
S3849 |
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S3850 |
|
|
S3851 |
|
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S3853 |
|
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S3860 |
|
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S3861 |
|
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S3862 |
|
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S3800 |
Manually priced with no age or diagnosis restrictions; requires Prior Authorization. This procedure code requires prior authorization by AFMC based on the following criteria: (1) an ICD-9-CM diagnosis code of 335.20 and symptoms of muscle weakness, (2) documentation of muscle testing must be provided and (3) a completed evaluation by a neurologist to rule out other causes of muscle weakness. (See Section 241.00 regarding procedures for obtaining prior authorization by AFMC.) |
|
Procedure Code |
Description |
|
S3620 |
Newborn Metabolic Screening Panel |
Arkansas Code § 20-15-302 states that all newborn infants shall be tested for phenylketonuria, hypothyroidism, galactosemia, cystic fibrosis and sickle cell anemia. Arkansas Medicaid shall reimburse the enrolled Arkansas Medicaid hospital provider that performs the tests required for the cost of the tests. Newborn Metabolic Screenings performed inpatient are included in the interim per diem reimbursement rate and facility cost settlement. For Newborn Metabolic Screenings performed in the outpatient setting (due to retesting or as an initial screening), Arkansas Medicaid will reimburse the hospital directly. For the screenings performed in the outpatient hospital setting, the provider will submit a claim using procedure code S3620. All positive test results shall be sent immediately to the Arkansas Department of Health.
