Arkansas Administrative Code
Agency 016 - DEPARTMENT OF HUMAN SERVICES
Division 06 - Medical Services
Rule 016.06.19-013 - Hospital 3-19 Spinal Muscular Atrophy Newborn Screening
Current through Register Vol. 49, No. 9, September, 2024
272.450 Special Billing Requirements for Laboratory and X-Ray Services 1-1-20
The following codes have special billing requirements for laboratory and X-Ray procedures.
The following CPT procedure codes will be payable with a primary diagnosis as is indicated below.
|
Procedure Code |
Required Primary Diagnosis |
Special Instructions |
|
81479 |
None |
Requires paper billing with attachments that describe and justify the service represented by this procedure. |
|
81500 81503 |
(View ICD Codes.) |
18y and up. This code is restricted to female beneficiaries. Requires paper billing that describes and justifies the procedure. |
|
81508 81509 |
Diagnosis must indicate a current condition of pregnancy. |
None |
|
81510 |
||
|
81511 |
||
|
81512 |
||
|
81599* |
None |
For consideration of claims with unlisted procedure codes, such as 81599, see Section 252.111 for billing instructions on this unlisted procedure code. |
|
82777 |
(View ICD Codes.) |
18y and up |
|
83951 |
(View ICD Codes.) |
None |
|
86386 |
(View ICD Codes.) |
None |
|
86828 |
(View ICD Codes.) |
None |
|
86829 |
||
|
86830 |
||
|
86831 |
||
|
86832 |
||
|
86833 |
||
|
86834 |
||
|
86835 |
||
|
87389 |
(View ICD Codes.) |
None |
|
87901 |
None |
A maximum of 12 units per 12-month period |
|
87903 |
None |
A maximum of 1 unit per year |
|
87904 |
None |
This procedure code is an add-on code. |
|
87906 |
None |
A maximum of 12 units per 12-month period |
|
88720 |
(View ICD Codes.) |
None |
|
88740 |
(View ICD Codes.) |
None |
|
88741 |
(View ICD Codes.) |
None |
|
Procedure Code |
Payment Method |
|
S3831 |
Manually priced with no age or diagnosis restrictions |
|
S3840 |
|
|
S3844 |
|
|
S3846 |
|
|
S3849 |
|
|
S3850 |
|
|
S3853 |
|
|
S3861 |
|
|
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 diaanosis code of: (View ICD Codes.) 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 241.000 regarding procedures for obtaining prior authorization by AFMC.) |
|
Procedure Code |
Description |
|
83620 |
Newborn Metabolic Screening Panel |
Arkansas Code § 20-15-302 states that all newborn infants shall be tested for certain metabolic diseases. 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.
The list of metabolic diseases for which providers can bill under S3620 can be found within the Arkansas Department of Health (ADH) rules pertaining to testing of newborn infants.
