Arkansas Administrative Code
Agency 016 - DEPARTMENT OF HUMAN SERVICES
Division 06 - Medical Services
Rule 016.06.19-014 - ARKids First-B
Current through Register Vol. 49, No. 9, September, 2024
222.750 Health Education
Health education is a required component of screening services and includes anticipatory guidance. The developmental assessment, comprehensive, physical examination, and the visual, hearing or dental screening provide the initial opportunity for providing health education. Health education and counseling to parents (or guardians) and children are required. Health education and counseling are designed to assist in understanding what to expect in terms of the child's development and to provide information about the benefits of healthy lifestyles and practices, as well as accident and disease prevention. See Section 262.130 for procedure codes.
Health education can include but isn't limited to tobacco cessation counseling services to the parent/legal guardian of the child.
Current Procedure Code |
Current Modifier |
Arkansas Medicaid Description |
99406* |
SE |
*** (Smoking and tobacco use cessation counseling visit; intermediate, 15-minutes) |
99406* |
CG |
*** (Smoking and tobacco use cessation counseling visit, intermediate, 15-minutes provided to parents of children birth through twenty (20) years of age) |
99407* |
SE |
*** (Smoking and tobacco use cessation counseling visit; intensive, 30-minutes) |
99407* |
CG |
*** (Smoking and tobacco use cessation counseling visit, intensive, 30-minutes provided to parents of children birth through twenty (20) years of age) |
* Exempt from PCP referral requirements.
*** (...) This symbol, along with text in parentheses, indicates the Arkansas Medicaid description of the service. When using a procedure code with this symbol, the service must meet the indicated Arkansas Medicaid description.
Refer to Section 257.000 and Section 292.900 of the Primary Care Physician manual for more information.
272.452 Tobacco Cessation Counseling Services
*** (...) This symbol, along with text in parentheses, indicates the Arkansas Medicaid description of the service. When using a procedure code with this symbol, the service must meet the indicated Arkansas Medicaid description.
Current Procedure Code |
Current Modifier |
Arkansas Medicaid Description |
99406* |
SE |
*** (Smoking and tobacco use cessation counseling visit; intermediate, 15-minutes) |
99406* |
CG |
*** (Smoking and tobacco use cessation counseling visit, intermediate, 15-minutes provided to parents of children birth through twenty (20) years of age) |
99407* |
SE |
*** (Smoking and tobacco use cessation counseling visit; intensive, 30-minutes) |
99407* |
CG |
*** (Smoking and tobacco use cessation counseling visit, intensive, 30-minutes provided to parents of children birth through twenty (20) years of age) |
* Exempt from PCP referral requirements.
*** (...) This symbol, along with text in parentheses, indicates the Arkansas Medicaid description of the covered service. When using a procedure code with this symbol, the service must meet the indicated Arkansas Medicaid description.
The provider must complete the counseling checklist and place in the patient records for audit. A copy of the checklist is available at View or Print Be Well Arkansas Referral Form
Child Health Services/Early and Periodic Screening, Diagnosis, and Treatment
215.290 Health Education
Health education is a required component of screening services and includes anticipatory guidance. The developmental assessment, comprehensive physical examination, visual, hearing or dental screening provides the initial opportunity for providing health education. Health education and counseling to parents (or guardians) and children are required. Health education and counseling are designed to assist in understanding what to expect in terms of the child's development and to provide information about the benefits of healthy lifestyles and practices, as well as accident and disease prevention. See Section 242.100 for procedure codes.
Health education can include but isn't limited to tobacco cessation counseling services to the parent/legal guardian of the child.
Current Procedure Code |
Current Modifier |
Arkansas Medicaid Description |
99406* |
SE |
(Smoking and tobacco use cessation counseling visit; intermediate, 15-minutes) |
99406* |
CG |
*** (Smoking and tobacco use cessation counseling visit, intermediate, 15-minutes provided to parents of children birth through twenty (20) years of age) |
99407* |
SE |
*** (Smoking and tobacco use cessation counseling visit; intensive, 30-minutes) |
99407* |
CG |
*** (Smoking and tobacco use cessation counseling visit, intensive, 30-minutes provided to parents of children birth through twenty (20) years of age) |
* Exempt from PCP referral requirements.
*** (...) This symbol, along with text in parentheses, indicates the Arkansas Medicaid description of the service. When using a procedure code with this symbol, the service must meet the indicated Arkansas Medicaid description.
Refer to Section 257.000 and Section 292.900 of the Physician's manual for more information.
242.100 Procedure Codes
The table below contains procedure codes, the associated modifiers to be used with the individual code, and a description of each EPSDT service.
Procedure Code |
Modifier 1 |
Modifier 2 |
Description |
99381-99385 |
EP |
U1 |
EPSDT Periodic Complete Medical Screen (New Patient) |
99381-993851 |
EP |
H9 |
EPSDT Periodic Complete Medical Screen (Foster Care) |
99391-99395 |
EP |
U2 |
EPSDT Periodic Complete Medical Screen (Established Patient) |
99391-993951 |
EP |
H9 |
EPSDT Periodic Complete Medical Screen (Foster Care) |
99460 |
EP |
UA |
Initial Hospital/birthing center care, normal newborn (global) |
99461 |
EP |
UA |
Initial care normal newborn other than hospital/birthing center (global) |
99463 |
EP |
UA |
Initial hospital/birthing center care, normal newborn admitted/discharged same date of service (global) |
991731 |
EP |
EPSDT Periodic Vision Screen |
|
V50081 |
EP |
EPSDT Periodic Hearing Screen |
|
T1502 |
EP |
Admin, of oral, intramuscular, or subcutaneous medication by health care agency/professional, per visit. |
|
DO1201 |
CHS/EPSDT Oral Examination |
||
D01401 |
EPSDT Interperiodic Dental Screen, with prior authorization |
||
99401 |
EP |
EPSDT Health Education - Preventive Medical Counseling |
|
994061 |
SE |
*** (Smoking and tobacco use cessation counseling visit; intermediate, 15-minutes) |
|
99406 |
CG |
*** (Smoking and tobacco use cessation counseling visit, intermediate, 15-minutes provided to parents of children birth through twenty (20) years of age) |
|
994071 |
SE |
*** (Smoking and tobacco use cessation counseling visit; intensive, 30-minutes) |
|
99407 |
CG |
*** (Smoking and tobacco use cessation counseling visit, intensive, 30-minutes provided to parents of children birth through twenty (20) years of age) |
|
99070 |
EP |
Supplies and materials provided by physician over and above those covered by the office visit or other services rendered. |
|
364152 |
Collection of venous blood by venipuncture |
||
83655 |
Lead |
*** (...)This symbol, along with text in parentheses, indicates the Arkansas Medicaid description of the service. When using a procedure code with this symbol, the service must meet the indicated Arkansas Medicaid description.
Other coding information found in the chart:
Electronic and paper claims require use of modifiers. When filing paper claims for a Child Health Services (EPSDT) screening service, the applicable modifier must be entered on the claim form.
See Section 212.000 for Child Health Services (EPSDT) screening terminology.
NOTES
214.100 Tobacco Cessation Products and Counseling Services
Tobacco cessation products either prescribed or initiated through statewide pharmacist protocol are available without prior authorization (PA) to eligible Medicaid beneficiaries. Additional information can be found on the DHS Contracted Pharmacy Vendor website or in the Prescription Drug Program Prior Authorization Criteria.
Counseling services and benefits are defined below:
NOTE: The course of treatment is defined as three consecutive months.
252.454 Tobacco Cessation Products and Counseling Services
Current Procedure Code |
Current Modifier |
Arkansas Medicaid Description |
99406* |
SE |
*** (Smoking and tobacco use cessation counseling visit; intermediate, 15-minutes) |
99406* |
CG |
*** (Smoking and tobacco use cessation counseling visit, intermediate, 15-minutes provided to parents of children birth through twenty (20) years of age) |
99407* |
SE |
*** (Smoking and tobacco use cessation counseling visit; intensive, 30-minutes) |
99407* |
CG |
*** (Smoking and tobacco use cessation counseling visit, intensive, 30-minutes provided to parents of children birth through twenty (20) years of age) |
* Exempt from PCP referral requirements.
*** (...) This symbol, along with text in parentheses, indicates the Arkansas Medicaid description of the service. When using a procedure code with this symbol, the service must meet the indicated Arkansas Medicaid description.
The provider must complete the counseling checklist and place in the patient records for audit. A copy of the checklist is available at View or Print Be Well Arkansas Referral Form
201.100 Arkansas Medicaid Participation Requirements for Pharmacies Administering Vaccines
The Arkansas Medicaid Program will reimburse pharmacies the cost and administration fee for selected vaccines and immunizations for Medicaid beneficiaries seven (7) years of age to eighteen (18) years of age under a general written protocol and written consent of the parent or legal guardian of the minor. Consent must be obtained before the administration of the vaccine or immunization. Written protocol and consent must be retained and is subject to reporting requirements. The Arkansas Medicaid Program will continue to reimburse pharmacies the cost and administration fee of selected vaccines for Medicaid beneficiaries nineteen (19) years of age and older. For a complete list of covered vaccines and CMS-1500 billing instructions, please refer to the CMS-1500 Claim Form Billing Instructions.
The Arkansas Medicaid Program will reimburse pharmacies the administration fee for selected vaccines that are obtained through the Vaccine for Children Program (VFC) or ARKids-B SCHIP Vaccine Program. Please refer to section 292.950 of the Physician manual for VFC vaccines billing procedures and section 262.430 for ARKids-B SCHIP vaccine. All Arkansas State Board of Pharmacy laws and regulations will apply.
To be eligible for participation, the pharmacy must meet the following criteria, in addition to those specified in Section 201.000:
Refer to Section 210.100 for scope of coverage; Section 213.000 for benefit limits.
211.000 Scope
The Arkansas Medicaid Pharmacy Program conforms to the Medicaid Prudent Pharmaceutical Purchasing Program (MPPPP) that was enacted as part of the Omnibus Budget Reconciliation Act (OBRA) of 1990. This law requires Medicaid to limit coverage to drugs manufactured by pharmaceutical companies that have signed rebate agreements. A numeric listing of approved pharmaceutical companies and their respective labeler codes is located on the DHS Contracted Pharmacy Vendor website. View or print numeric listing of approved pharmaceutical companies and their respective labeler codes. Except for drugs in the categories excluded from coverage, Arkansas Medicaid covers all drug products manufactured by companies with listed labeler codes. Additions or deletions by labelers are submitted to the State by the Centers for Medicare and Medicaid Services (CMS), the website will be updated.
The Arkansas Medicaid Program will cover the following drug categories:
As changes are made to the drug coverage, providers will be notified of the revisions.
The Arkansas Medicaid Program will reimburse pharmacies the cost and administration fee for selected vaccines and immunizations for Medicaid beneficiaries age seven (7) years of age to eighteen (18) years of age under a general written protocol and written consent of the parent or legal guardian of the minor. Consent must be obtained before the administration of the vaccine or immunization. Written protocol and consent must be retained and is subject to reporting requirements. The Arkansas Medicaid Program will continue to reimburse pharmacies the cost and administration fee of selected vaccines for Medicaid beneficiaries age nineteen (19) and older. For a complete list of covered vaccines and CMS-1500 billing instructions, please refer to the CMS-1500 Claim Form Billing Instructions . No primary care physician (PCP) referral is required to administer the vaccines.
The influenza virus vaccine is limited to one (1) per state fiscal year (July through June). The pneumococcal polysaccharide vaccine is limited to one every ten (10) years.
The Arkansas Medicaid Program will reimburse pharmacies the administration fee for selected vaccines that are obtained through the Vaccine for Children Program (VFC) or ARKids-B SCHIP Vaccine program. Please refer to section 292.950 of the Physician manual for VFC vaccines billing procedures and section 262.430 for ARKids-B SCHIP vaccine. No primary care physician (PCP) referral is required to administer the vaccines. All Arkansas State Board of Pharmacy laws and regulations will apply.
Effective 8/1/15, ARKids-B beneficiaries are no longer eligible for the VFC program. However, providers are still able to obtain vaccines to administer to ARKids-B beneficiaries by contacting the Arkansas Department of Health (ADH) and indicating the need to order "ARKids-B SCHIP vaccines or Vaccines for Children (VFC)." VFC vaccines can also still be obtained by contacting ADH. For dates of service on or after 8/1/15, modifier "SL" will be required when billing for the administration of SCHIP vaccines to ARKids-B beneficiaries. Modifier EP, TJ is required when billing for administration of VFC vaccines for ARKids-A beneficiaries.
Medicaid will reimburse the Medicare deductible or coinsurance for all beneficiaries receiving both Medicare and Medicaid benefits in reference to vaccines.
Pharmacies must use the CMS-1500 claim form when billing Medicaid for these vaccines.
241.000 Coverage of Tobacco Cessation Products
Effective for claims with dates of service on or after January 1, 2020, coverage of tobacco cessation products either prescribed or initiated through statewide pharmacist protocol is available without prior authorization (PA) to eligible Medicaid beneficiaries. Additional information can be found on the DHS Contracted Pharmacy Vendor website or in the Prescription Drug Program Prior Authorization Criteria.
Coverage and Limitations
257.000 Tobacco Cessation Products and Counseling Services
Tobacco cessation products either prescribed or initiated through statewide pharmacist protocol are available without prior authorization (PA) to eligible Medicaid beneficiaries. Additional information can be found on the DHS Contracted Pharmacy Vendor website or in the Prescription Drug Program Prior Authorization Criteria.
292.900 Tobacco Cessation Counseling Services
*** (...) This symbol, along with text in parentheses, indicates the Arkansas Medicaid description of the service. When using a procedure code with this symbol, the service must meet the indicated Arkansas Medicaid description.
Current Procedure Code |
Current Modifier |
Arkansas Medicaid Description |
99406* |
SE |
*** (Smoking and tobacco use cessation counseling visit; intermediate, 15-minutes) |
99406* |
CG |
*** (Smoking and tobacco use cessation counseling visit, intermediate, 15-minutes provided to parents of children birth through twenty (20) years of age) |
99407* |
SE |
*** (Smoking and tobacco use cessation counseling visit; intensive, 30-minutes) |
99407* |
CG |
*** (Smoking and tobacco use cessation counseling visit, intensive, 30-minutes provided to parents of children birth through twenty (20) years of age) |
* Exempt from PCP referral.
Oral surgeons must use procedure code D9920 for one 15-minute unit and procedure code D1320 for one 30-minute unit when filing claims on the American Dental Association (ADA).
See Section 257.000 of this manual for coverage and benefit limit information.