Arkansas Administrative Code
Agency 016 - DEPARTMENT OF HUMAN SERVICES
Division 27 - Department of Medical Services
Rule 016.27.20-002 - Ambulatory Surgical Center Manual (ASC-1-19)
Universal Citation: AR Admin Rules 016.27.20-002
Current through Register Vol. 49, No. 9, September, 2024
Section II
Ambulatory Surgical Center
222.000
ASC Procedures That Require
Medical Review, Prior Authorization, and Diagnosis Code Restriction
A. The procedure codes found in the following
link require medical review, prior authorization, or diagnosis restriction as
of the effective date indicated. View or print the procedure
codes for ASC services.
B. For dates of service on or after November
1, 2017 the following procedure codes require prior authorization.
|
Outpatient Surgery Abortion Codes That Require Prior Authorization |
|
59840 59841 59866 |
1. Refer to
Section 216.110, "Abortion When Life of Mother Would Be Endangered If the Fetus
Were Carried to Term," for the prior authorization process.
2. Refer to Section 216.120, "Abortion When
the Pregnancy Is a Result of Rape or Incest," for the prior authorization
process.
3. Abortion claims must be
billed on a paper CMS-1450 (UB-04) claim form with the DMS-2698 form
(Certification Statement for Abortion), history and physical, and operative
report attached.View a sample CMS-1450 (UB-04) claim form.
View or print form DMS-2698.
Disclaimer: These regulations may not be the most recent version. Arkansas may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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