016-06-06 Ark. Code R. § 14

Current through Register Vol. 49, No. 6, June, 2024

Rule 016.06.06-014 - 2006 National CPT and HCPCS Procedure Codes.

2006 CPT Procedure Code Conversion

II.Non-Covered 2006 CPT Procedure Codes

A. The following 2006 CPT procedure codes are non-covered for all providers.

43770	43771	43772	43773	43774
43886	43887	43888	83037	90649
90736	90760	90761	90773	95251
96102	96103	96116	96119	96120
97760	97761	98960	98961	98962
99324	99325	99326	99327	99328
99334	99335	99336	99337	99339
99340

B. The following 2006 CPT procedure codes are not payable to outpatient hospital and ambulatory surgical centers because these services are covered by another CPT procedure code, another HCPCS code, or a revenue code.

15111	15116	15131	15136	15151
15152	15156	15157	15171	15176
15301	15321	15331	15336	15341
15361	15366	15421	15431	22525
33768	33884	37185	37186	44213
58110	61641	61642	75956	75957
75958	75959	90766	90767	90768
90774	90775

C. Effective for dates of service on and after March 1, 2006, the following currently payable CPT procedure codes will become non-payable because the services are covered by another CPT procedure code or another HCPCS code for physicians, osteopaths and AHECS.

99050

99056

99058

Effective for dates of service on and after March 1, 2006, the following 2006 CPT procedure codes will be non-payable because the services are covered by another CPT procedure code or HCPCS code for physicians, osteopaths and AHECS.

90772

99051

99053

99060

D. All 2006 CPT procedure codes listed in Category II and Category III are non-

covered.

III.Prior Authorization

The following 2006 CPT procedure codes require prior authorization (PA).01966

For procedure code 01966, the source for prior authorization is determined by the same criteria as deleted code 01964.

IV.Diagnosis Codes

Effective for dates of service on and after March 1, 2006, diagnosis codes in range 230.0 through 238.9 are also recognized as cancer diagnosis codes.

V.Special Billing Requirements

A. The following 2006 CPT procedure codes require paper claims and supporting documentation.

01965	Procedure requires ICD-9-CM diagnosis code 631, 632, or 634.00 through 634.92
01966	Procedure requires prior authorization. For Medicaid, provider manual protocol and billing requirements must be followed the same as the deleted procedure code 01964.
44180 45499 45990 51999	Claim requires operative report.
76376 76377	Claim requires medical history and physical
28890	History and physical showing treatment failure of previous conservative therapy, (i.e. NSAIDS, cortisone shots, and physical therapy)

B. The following 2006 CPT procedure codes require documentation to justify the procedure billed, except when the claim is for diagnosis codes 940.0 through 949.5.

15170

15171

15175

15176

VI.Podiatry Program

The following procedure codes are payable to podiatry providers.

15115	15116	15135	15136	15155
15156	15157	15170*	15171*	15175*
15176*	15320	15321	15335	15336
15340	15341	15365	15366	15420
15421	28890	99304	99305	99306
99307	99308	99309	99310	99318

* These procedure codes require documentation to justify the procedure billed, except when the claim is for diagnosis codes 940.0 through 949.5.

VII.Certified Nurse-Midwife

A. The following 2006 CPT procedure codes are payable to certified nurse-midwife providers.

90765	90766	90767	90768	90774
90775	90779

B. Effective for dates of service on and after March 1, 2006, CPT procedure code 90799 is replaced by existing HCPCS procedure code T1502. HCPCS procedure code T1502 is to be used for "administration only" of IM and/or subcutaneous injections and requires a modifier U1 when billed electronically or on paper. Use type of service "9" when filing paper claims. Procedure code T1502 must be billed when the drug is not supplied by the provider who administers the drug.

VIII.Nurse Practitioner

A. The following 2006 CPT procedure codes are payable to nurse practitioner providers.

90714	90765	90766	90767	90768
90774	90775	90779	96401	96402
96409	96411	96413	96415	96416
96417	96521	96522	96523	97760
97761	97762	99304	99305	99306
99307	99308	99309	99310	99318

B. Effective for dates of service on and after March 1, 2006, CPT procedure code 90799 is replaced by existing HCPCS procedure code T1502. HCPCS procedure code T1502 is to be used for "administration only" of IM and/or subcutaneous injections. Procedure code T1502 may be billed electronically or on paper. Use type of service "N" when filing paper claims. Procedure code T1502 must be billed when the drug is not supplied by the provider who administers the drug.

IX.Oral Surgeon

A. The following CPT procedure codes are payable to oral surgeons effective for dates of service on and after March 1, 2006.

15040	15115	15116	15135	15136
15155	15156	15157	15175*	15176*
15320	15321	15335	15336	15365
15366	15420	15421	90765	90766
90767	90768	90774	90775	90779
99143	99144	99145	99148	99149
99150

* These procedure codes require documentation to justify the procedure billed, except when the claim is for diagnosis codes 940.0 through 949.5.

B. Effective for dates of service on and after March 1, 2006, CPT procedure code 90799 is replaced by existing HCPCS procedure code T1502. HCPCS procedure code T1502 is to be used for "administration only" of IM and/or subcutaneous injections. Procedure code T1502 may be billed electronically or on paper. Use type of service "1" when filing paper claims. Procedure code T1502 must be billed when the drug is not supplied by the provider who administers the drug

X.Outpatient Hospital

Use procedure code 90765 for IV infusion therapy. For additional hours, sequential and/or concurrent infusions, bill revenue code 0760 (for observation), up to 8 hours maximum per day.

XI.Physician

Effective for dates of service on and after March 1, 2006, CPT procedure code 90799 is replaced by existing HCPCS procedure code T1502. HCPCS procedure code T1502 is to be used for "administration only" of IM and/or subcutaneous injections. Procedure code T1502 may be billed electronically or on paper. Use type of service "1" when filing paper claims. Procedure code T1502 must be billed when the drug is not supplied by the provider who administers the drug.

XII.Child Health Services (EPSDT

Effective for dates of service on and after March 1, 2006, CPT procedure code 90799 is replaced by existing HCPCS procedure code T1502. HCPCS procedure code T1502 is to be used for "administration only" of IM and/or subcutaneous injections. Procedure code T1502 may be billed electronically or on paper. Use type of service "6" when filing paper claims. Procedure code T1502 must be billed when the drug is not supplied by the provider who administers the drug.

XIII.Child Health Management Services (CHMS)

A. Effective for dates of service on and after March 1, 2006, the following 2006 CPT

procedure codes are payable to CHMS programs.

96101

96118

97762

B. Procedure code 96100 has been deleted from the 2006 CPT book and is replaced by 96101. The following modifiers must be used with 96101 when filing claims for the CHMS services

Modifier(s)	Description
UA, UB	Psychological Testing Battery
U1, UA	Psychological Testing - children entering foster care
UA	Interpretation - children entering foster care

C. CHMS procedure code 96117 has been deleted from 2006 CPT. This procedure code has been replaced with procedure code 96118.

D. CHMS procedure code 97703 has been deleted from 2006 CPT. It is replaced with 97762. Procedure code 97762 will require PA as all other CHMS treatment procedures.

XIV.Rehabilitative Services for Persons with Mental Illness

A. Effective for dates of service on and after March 1, 2006, procedure code 96100 has been deleted and is non-payable. It has been replaced with 2006 CPT procedure code 96101.

B. The modifiers listed below must be used with procedure code 96101 when filing claims for the RSPMI services described.

Modifier(s)	Description
HA, UA	Diagnosis - Psychological Test/Evaluation
HA, UA, UB	Diagnosis - Psychological Testing Battery

XV.School-Based Mental Health (SBMH)

Effective for dates of service on and March 1, 2006, procedure code 96100 has been deleted and is non-payable. It is replaced by procedure code 96101. The modifiers listed below must be used with procedure code 96101 when filing claims for the SBMH services described.

Modifier(s)	Description
UA	Diagnosis - Psychological Test/Evaluation
UA, UB	Diagnosis - Psychological Testing Battery

XVI.Licensed Mental Health Practitioner (LMHP)

Effective for dates of service on and after March 1, 2006, procedure code 96100 has been deleted and is non-payable. It is replaced by procedure code 96101. The modifiers listed below must be used with procedure code 96101 when filing claims for the LMHP services described. This procedure is only payable to psychologists.

Modifier(s)	Description
UA	Diagnosis - Psychological Test/Evaluation
UA, UB	Diagnosis - Psychological Testing Battery

XVII.Rehabilitative Services for Youth and Children (RSYC)

Effective for dates of service on and after March 1, 2006, procedure code 96100 has been deleted and is non-payable. It is replaced by procedure code 96101. The modifiers listed below must be used with procedure code 96101 when filing claims for the RSYC services described.

Modifier(s)	Description
UA, UB	Psychological Testing Battery

XVIII.Additional Information

Complete descriptions of CPT 2006 procedure codes are in the CPT 2006 book. This book may be purchased from Ingenix online at http://www.ingenixonline.com/or by calling 1-800-464 -3649.

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) 682-6789.

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

SUBJECT: 2006 HCPCS Procedure Code Conversion

I.General Information

A review of the 2006 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, 2006.

II.2006 HCPCS Payable Procedure Code Tables Information

Payable procedure codes have been broken into separate tables. Tables have been created for each affected provider type (e.g.: physician, hospital etc.).

The tables are designed with nine columns of information. All columns may not be applicable for each covered program, but have been devised for ease of reference.

The first column contains the HCPCS procedure code. In some instances, the procedure code will be shown in multiples, depending on the number of types of service (TOS) for which it can be used by a provider.

The second column contains the type of service (TOS) code that may be used in conjunction with the procedure code. TOS codes are used with procedure codes billed on paper. This information is provided when pertinent to billing protocol.

The third column shows procedure codes that require manual pricing and is titled Manually Priced Y/N. A letter "Y" in the column indicates that an item is manually priced and an "N" shows that an item is not manually priced. This information is provided when pertinent to billing protocol. Providers should consult their program manual to review the process involved in manual pricing.

The fourth and fifth columns indicate the beginning and ending range for diagnoses for which a procedure code may be used. (e.g.: 0530 through 0549). The information is used, for example, by physicians, hospitals and others.

The sixth column indicates the diagnosis list for which a procedure code may be used. This information is used, for example, by physicians, hospitals and other provider types. Applicable lists will be shown in each provider's section.

The seventh column indicates whether a procedure undergoes medical review before payment. The column is titled "Review Y/N". The letter "Y" in the column indicates that a review is necessary; and an "N" indicates that a review is not necessary. Providers should consult their program manual to obtain the information that is needed for a review.

The eighth column shows procedure codes that require prior authorization (PA) before the service may be provided. The column is titled "PA Y/N". The letter "Y" in the column indicates that a procedure code requires prior authorization and an "N" means the code does not require prior authorization. Providers should consult their program manual to ascertain what information should be provided for the prior authorization process.

The ninth column indicates any modifiers that must be used in conjunction with the procedure code, when billed, either electronically or on paper.

III.Diagnosis Range and Diagnosis Lists

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

Diagnosis List 003

ICD 9 Codes

042, 140.0 through 208.91

230.0 Through 238.9

Diagnosis List 027

ICD 9 Codes

20500, 20501, 20510, 20511, 20520, 20521, 20530, 20531, 20580, 20581,

20590, 20591, 2387

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

Please Note: Procedure code S2078 described as "Laparoscopic supracervical hysterectomy (subtotal hysterectomy), with or without removal of tubes(s), with or without removal of ovary(s)" is not covered by Arkansas Medicaid.

2006 Codes	TOS	Manually Priced Y/N	Beginning Diagnosis Range	Ending Diagnosis Range	Diagnosis List	Review Y/N	PA Y/N	Modifier
C9225			36320	36320		Y	N
J1265						N	N
J7341						N	N

V.HCPCS Procedure Codes Payable to End Stage Renal Disease Providers (ESRD)

2006 Codes	TOS	Manually Priced Y/N	Beginning Diagnosis Range	Ending Diagnosis Range	Diagnosis List	Review Y/N	PA Y/N	Modifier
J0881						N	N
J0882			584	586		N	N
J0885						N	N
J0886			584	586		N	N
J1751			2809	2809		N	N
J1752			2809	2809		N	N

VI.HCPCS Procedure Codes Payable to Family Planning

* Family planning services require a family planning detail diagnosis code.

2006 Codes	TOS	Manually Priced Y/N	Beginning Diagnosis Range	Ending Diagnosis Range	Diagnosis List	Review Y/N	PA Y/N	Modifier
J7306	A					N	N	FP

VII.HCPCS Procedure Codes Payable to Federally Qualified Health Centers (FQHC)

* Family planning services require a family planning detail diagnosis code.

2006 Codes	TOS	Manually Priced Y/N	Beginning Diagnosis Range	Ending Diagnosis Range	Diagnosis List	Review Y/N	PA Y/N	Modifier
J7306	A					N	N	FP

VIII.HCPCS Procedure Codes Payable to Home Health

2006 Codes	TOS	Manually Priced Y/N	Beginning Diagnosis Range	Ending Diagnosis Range	Diagnosis List	Review Y/N	PA Y/N	Modifier
A5120	H	N				N	N
A6549	H	Y				N	Y
J0881	H	Y				N	N
J0882	H	N	584	586		N	N
J0885	H	Y				N	N
J0886	H	N	584	586		N	N

IX.HCPCS Procedure Codes Payable to Hospitals

The following information is related to procedure codes found in the hospital chart.

* Prior approval is required before services associated with the use of procedure codes A9542, A9543, A9544 and A9545 may be provided. To obtain prior approval, the provider must obtain a prior approval letter from the Arkansas Medicaid Medical Director and furnish the following documentation.

A. The FDA approved diagnosis clearly stated.

B. Treatment failures that the patient has previously experienced.

C. The patient's history and physical report.

** Prior approval is required before services associated with the use of procedure code A9547 may be provided. To obtain prior approval, the provider must:

A. Submit the patient's history and physical

B. Provide a report of the ultrasound or computerized axial tomography (CAT) that was not diagnostic.

*** Prior approval is required for the service associated with the use of procedure code A9555. To obtain prior approval, the provider must:

A. Submit a history and physical

B. Submit a report on what other profusion scans have been tried and are non-diagnostic.

# Protocol for galsulase (procedure code C9224) includes the following:

A. Galsulase requires prior approval by the Medical Director of the Division of Medical Services. Payment is not approved without approval. It is the ordering physician's responsibility to request approval for galsulase. When approval is granted, an approval letter will be sent to the physician.

B. The physician is to provide a copy of the approval letter to the hospital along with the physician's order for the drug when administered in the outpatient or emergency place of service.

C. When billing galsulase, the hospital must file a paper claim using C9224. A copy of the approval letter must be attached for payment to be approved. The primary detail diagnosis must be billed as 277.6.

* Procedure code J7306 is covered for family planning. Family planning services require a family planning detail diagnosis code.

^##Procedure code Q4079 requires review prior to payment.

A. This procedure code must be billed on a paper claim.

B. Submit the history and physical showing a relapse of multiple sclerosis.

Please Note: Procedure code S2078 described as "Laparoscopic supracervical hysterectomy (subtotal hysterectomy), with or without removal of tubes(s), with or without removal of ovary(s)" is not covered by Arkansas Medicaid

2006 Codes	TOS	Manually Priced Y/N	Beginning Diagnosis Range	Ending Diagnosis Range	Diagnosis List	Review Y/N	PA Y/N	Modifier
A9535			2897	2897		N	N
A9536						N	N
A9537						N	N
A9538						N	N
A9539						N	N
A9540						N	N
A9541						N	N
A9542*						Y	N
A9543*						Y	N
A9544*						Y	N
A9545*						Y	N
A9547**						Y	N
A9548						N	N

IX.HCPCS Procedure Codes Payable to Hospitals

2006 Codes	TOS	Manually Priced Y/N	Beginning Diagnosis Range	Ending Diagnosis Range	Diagnosis List	Review Y/N	PA Y/N	Modifier
A9549			1548	1548		Y	N
A9550						N	N
A9551						N	N
A9552						N	N
A9553						N	N
A9554						N	N
A9555***						Y	N
A9556						N	N
A9557			430	43491		Y	N
A9558						N	N
A9559			2810	2810		N	N
A9560						N	N
A9561						N	N
A9562						N	N
A9563			2384	2384		N	N
A9564						N	N
A9565						N	N
A9567						N	N
C2637						N	N
C9224#			2776	2776		Y	N
C9225			36320	36320		Y	N
J0132			9654	9654		N	N
J0133			0530	0549		N	N
J0278					003	N	N
J0480			V420	V420		N	N
J0795					003	N	N
J0881						N	N
J0882			584	586		N	N
J0885						N	N
J0886			584	586		N	N
J1162			9721	9721		N	N
J1265						N	N
J1451			9800	9801		N	N
J1566						Y	N
J1567						Y	N
J1640			2771	2771		N	N
J1751			2809	2809		N	N
J1752			2809	2809		N	N
J1945			9642	9642		N	N
J2278					003	N	N
J2325			4280	4289		N	N
J2425					003	N	N
J2503			36250	36252		N	N
J2504						Y	N
J2513						N	N
J3285			4160	4160		N	N
J7188			2864	2864		N	N
J7189						Y	N
J7306						N	N
J7341						N	N
J9025					027	N	N
J9027						N	N
J9225			185	185		N	N
J9264					003	N	N
Q4079##						Y	N
S0145			07054	07054		N	N
S0146			07054	07054		N	N

X.HCPCS Procedures Codes Payable to Independent Radiology

The following information is related to certain codes found within the independent radiology section below.

* Prior approval is required before services associated with the use of procedure codes A9542, A9543, A9544 and A9545 may be provided. To obtain prior approval, the provider must obtain a prior approval letter from the Arkansas Medicaid Medical Director and furnish the following documentation.

A. The FDA approved diagnosis clearly stated.

B. Treatment failures that the patient has previously experienced.

C. The patient's history and physical report.

** Prior approval is required before services associated with the use of procedure code A9547 may be provided. To obtain prior approval, the provider must:

A. Submit the patient's history and physical

B. Provide a report of the ultrasound or computerized axial tomography (CAT) that was not diagnostic.

*** Prior approval is required for the service associated with the use of procedure code A9555. To obtain prior approval, the provider must:

A. Submit a history and physical

B. Submit a report on what other profusion scans have been tried and are non-diagnostic.

A9535	1		2897	2897		N	N
A9536	1					N	N
A9537	1					N	N
A9538	1					N	N
A9539	1					N	N
A9540	1					N	N
A9541	1					N	N
A9542*	1					Y	N
A9543*	1					Y	N
A9544*	1					Y	N
A9545*	1					Y	N
A9547**	1					Y	N
A9548	1					N	N
A9549	1		1548	1548		Y	N
A9550	1					N	N
A9551	1					N	N
A9552	1					N	N
A9553	1					N	N
A9554	1					N	N
A9555***	1					Y	N
A9556	1					N	N
A9557	1		430	43491		Y	N
A9558	1					N	N
A9559	1		2810	2810		N	N
A9560	1					N	N
A9561	1					N	N
A9562	1					N	N
A9563	1		2384	2384		N	N
A9564	1					N	N
A9565	1					N	N
A9567	1					N	N

XI.HCPCS Procedure Codes Payable to Nurse Midwives

Please Note: Bill T1502-U1 when the drug is not supplied by the provider who administers the drug.

2006 Codes	TOS	Manually Priced Y/N	Beginning Diagnosis Range	Ending Diagnosis Range	Diagnosis List	Review Y/N	PA Y/N	Modifier
J1751	9		2809	2809		N	N
J1752	9		2809	2809		N	N
T1502	9					N	N	U1

XII.HCPCS Procedure Codes Payable to Nurse Practitioners

The following is information for procedure codes found in the chart below.

* Procedure code J7306 is covered for family planning. Family planning services require a family planning detail diagnosis code.

* Bill T1502 when the drug is not supplied by the provider who administers the drug.

2006 Codes	TOS	Manually Priced Y/N	Beginning Diagnosis Range	Ending Diagnosis Range	Diagnosis List	Review Y/N	PA Y/N	Modifier
J0881	N					N	N
J0882	N		584	586		N	N
J0885	N					N	N
J0886	N		584	586		N	N
J1566	N					Y	N
J1567	N					Y	N
J1751	N		2809	2809		N	N
J1752	N		2809	2809		N	N
J2278	N				003	N	N
J7306	A					N	N	FP
T1502*	N					N	N

XIII.HCPCS Procedure Codes Payable to Oral Surgeons

* Bill T1502 when the drug is not supplied by the provider who administers the drug.

2006 Codes	TOS	Manually Priced Y/N	Beginning Diagnosis Range	Ending Diagnosis Range	Diagnosis List	Review Y/N	PA Y/N	Modifier
T1502*	1					N	N

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

The following information is related to certain procedure codes found in the physician list.

* Prior approval is required before services associated with the use of procedure codes A9542, A9543, A9544 and A9545 may be provided. To obtain prior approval, the provider must obtain a prior approval letter from the Arkansas Medicaid Medical Director and furnish the following documentation.

A. The FDA approved diagnosis clearly stated.

B. Treatment failures that the patient has previously experienced.

C. The patient's history and physical report.

** Prior approval is required before services associated with the use of procedure code A9547 may be provided. To obtain prior approval, the provider must:

A. Submit the patient's history and physical

B. Provide a report of the ultrasound or computerized axial tomography (CAT) that was not diagnostic.

*** Prior approval is required for the service associated with the use of procedure code A9555. To obtain prior approval, the provider must:

A. Submit a history and physical

B. Submit a report on what other profusion scans have been tried and are non-diagnostic.

Please Note: Protocol for galsulase (procedure code J3490) includes the following:

A. Physicians may bill galsulase utilizing procedure code J3490.

B. Galsulase injections may be provided in the outpatient hospital, emergency room, or office place of service.

If provided in the office, the following conditions apply:

1. The provider must have nursing staff available to monitor the patient's vital signs during the infusion.

2. The provider must be able to treat anaphylactic shock in the treatment area where the drugs are infused.

C. When the physician determines the injection is needed for a Medicaid beneficiary, he or she must obtain prior approval from the Medical Director for the Division of Medical Services before beginning therapy.

D. The prior approval request must include:

1. Documentation of an office visit in includes a physical examination specifically identified by its date and must note the diagnosis.

2. Medical history that includes an annotated list of previous treatment protocols administered and their results.

3. Statement of medical necessity by a Genetics physician, which must include the method of diagnosis.

E. All approval letters are issued by the Medical Director's office.

F. If galsulase is to be provided in the outpatient hospital or emergency room, it is the ordering physician's responsibility to request approval for galsulase.

1. When approval is granted, an approval letter must be sent to the physician.

2. The physician must provide a copy of the approval letter to the hospital along with the physician's order for the drug when administered in the outpatient or emergency place of service.

G. When billing galsulase, the physician must file a paper claim using J3490. A copy of the approval letter must be attached for payment to be approved. The primary detail diagnosis must be billed as 277.6.

* Procedure code J7306 is covered for family planning. Family planning services require a family planning detail diagnosis code.

^##Procedure code Q4079 requires review prior to payment.

A. This procedure code must be billed on a paper claim.

B. Submit the history and physical showing a relapse of multiple sclerosis.

* Bill T1502 when the drug is not supplied by the provider who administers the drug.

* Bill T1502 EP when the drug is not supplied by the provider who administers the drug.

Please Note: Procedure code S2078 described as "Laparoscopic supracervical hysterectomy (subtotal hysterectomy), with or without removal of tubes(s), with or without removal of ovary(s)" is not covered by Arkansas

2006 Codes	TOS	Manually Priced Y/N	Beginning Diagnosis Range	Ending Diagnosis Range	Diagnosis List	Review Y/N	PA Y/N	Modifier
A9535	1		2897	2897		N	N
A9536	1					N	N
A9537	1					N	N
A9538	1					N	N
A9539	1					N	N
A9540	1					N	N
A9541	1					N	N
A9542*	1					Y*	N
A9543*	1					Y*	N
A9544*	1					Y*	N
A9545*	1					Y*	N
A9547**	1					Y**	N
A9548	1					N	N
A9549	1		1548	1548		Y	N
A9550	1					N	N
A9551	1					N	N
A9552	1					N	N
A9553	1					N	N
A9554	1					N	N
A9555	1					Y***	N
A9556	1					N	N
A9557	1		430	43491		Y	N
A9558	1					N	N
A9559	1		2810	2810		N	N
A9560	1					N	N
A9561	1					N	N
A9562	1					N	N
A9563	1		2384	2384		N	N
A9564	1					N	N
A9565	1					N	N
A9567	1					N	N
J0133	1		0530	0549		N	N
J0278	1				003	N	N
J0480	1		V420	V420		N	N
J0795	1				003	N	N
J0881	1					N	N
J0882	1		584	586		N	N
J0885	1					N	N
J0886	1		584	586		N	N
J1566	1					Y	N
J1567	1					Y	N
J1640	1		2771	2771		N	N
J1751	1		2809	2809		N	N
J1752	1		2809	2809		N	N
J2278	1				003	N	N
J2425	1				003	N	N
J2503	1		36250	36252		N	N
J2504	1					Y	N
J2513	1					N	N
J7306	A					N	N	FP
J7341	1					N	N
J9025	1				027	N	N
J9225	1		185	185		N	N
J9264	1				003	N	N
Q4079##	1					Y	N
S0145	1		07054	07054		N	N
S0146	1		07054	07054		N	N
T1502*	1					N	N
T1502*	6					N	N	EP

XV.HCPCS Procedure Codes Payable to Podiatrists

2006 Codes	TOS	Manually Priced Y/N	Beginning Diagnosis Range	Ending Diagnosis Range	Diagnosis List	Review Y/N	PA Y/N	Modifier
J7341	4					N	N

XVI.HCPCS Procedure Codes Payable to Private Duty Nursing

2006 Codes	TOS	Manually Priced Y/N	Beginning Diagnosis Range	Ending Diagnosis Range	Diagnosis List	Review Y/N	PA Y/N	Modif ier
A6549	S	Y				N	N
A6549	1	Y				N	Y

XVII.HCPCS Procedure Codes Payable to Prosthetics

2006 Codes	TOS	Manually Priced Y/N	Beginning Diagnosis Range	Ending Diagnosis Range	Diagnosis List	Review Y/N	PA Y/N	Modifier
A5120	H	N				N	N
A5512	H	N	25000	25193		N	N
A5513	H	N	25000	25193		N	N
A6513	H	Y				N	Y
A6530	H	Y				N	N
A6530	6	Y				N	N
A6549	H	Y				N	Y
E0705	H	N				N	Y
E0705	6	N				N	N	EP
E0911	H	N				N	N
E0911	6	N				N	N	EP
E0911	I	N				N	N
E2207	H	N				N	N
E2207	6	N				N	N	EP
E2208	H	N				N	N
E2208	6	N				N	N	EP
E2209	H	N				N	N
E2209	6	N				N	N	EP
E2210	H	N				N	N
E2210	6	N				N	N	EP
E2211	H	N				N	N
E2211	6	N				N	N	EP
E2212	H	N				N	N
E2212	6	N				N	N	EP
E2213	H	N				N	N
E2213	6	N				N	N	EP
E2214	H	N				N	N
E2214	6	N				N	N	EP
E2215	H	N				N	N
E2215	6	N				N	N	EP
E2220	H	N				N	N
E2220	6	N				N	N	EP
E2221	H	N				N	N
E2221	6	N				N	N	EP
E2226	H	N				N	N
E2226	6	N				N	N	EP
E2372	H	N				N	N
E2372	6	N				N	N	EP
L0621	H	N				N	N
L0621	6	N				N	N	EP
L0622	H	N				N	N
L0622	6	N				N	N	EP
L0623	H	N				N	N
L0623	6	N				N	N	EP
L0624	H	Y				N	N
L0624	6	Y				N	N	EP
L0625	H	N				N	N
L0625	6	N				N	N	EP
L0626	H	N				N	N
L0626	6	N				N	N	EP
L0627	H	N				N	N
L0627	6	N				N	N	EP
L0628	H	N				N	N
L0628	6	N				N	N	EP
L0629	H	Y				N	N
L0629	6	Y				N	N	EP
L0630	H	N				N	N
L0630	6	N				N	N	EP
L0631	H	N				N	N
L0631	6	N				N	N	EP
L0632	H	Y				N	N
L0632	6	Y				N	N	EP
L0633	H	N				N	N
L0633	6	N				N	N	EP
L0634	H	Y				N	N
L0634	6	Y				N	N	EP
L0635	H	N				N	N
L0635	6	N				N	N	EP
L0636	H	N				N	N
L0636	6	N				N	N	EP
L0637	H	N				N	N
L0637	6	N				N	N	EP
L0638	H	N				N	N
L0638	6	N				N	N	EP
L0639	H	N				N	N
L0639	6	N				N	N	EP
L0640	H	N				N	N
L0640	6	N				N	N	EP
L0859	H	N				N	Y
L0859	6	N				N	N	EP

Please Note: Effective for dates of service on and after March 1, 2006, a change in treatment of services associated with the procedure codes listed below will be in effect. Prior authorization will no longer be required when billing for the following items, however, the beneficiary's medical condition must fall within the diagnosis range of 250.00 and 251.93.

A5500

A5501

A5503

A5504

A5505

A5506

A5510

XVIII.HCPCCS Procedure Codes Payable to Transportation

2006 Codes	TOS	Manually Priced Y/N	Beginning Diagnosis Range	Ending Diagnosis Range	Diagnosis List	Review Y/N	PA Y/N	Modifier
J1265	E					N	N

XIX.Miscellaneous Changes

Several previously payable HCPCS or local codes have been deleted in the 2006 HCPCS conversion. The table below lists the deleted HCPCS or local code, any replacement code and the program(s) affected.

Replacement Code	Deleted Code	Program(s) Affected
A5120	A5119	Home Health, Prosthetics
A5512	A5509	Prosthetics
A5513	A5511	Prosthetics
A6530	L8100	Prosthetics
A6549	L8239	Home Health, Prosthetics
E0705	E0972	Prosthetics
E2207	K0102	Prosthetics
E2208	K0104	Prosthetics
E2209	K0106	Prosthetics
E2210	K0452	Prosthetics
E2211	K0067	Prosthetics
E2212	K0068	Prosthetics
E2213	K0064	Prosthetics
E2214	K0074	Prosthetics
E2215	K0078	Prosthetics
E2220	K0066	Prosthetics
E2221	K0076	Prosthetics
E2372	Z1663	Prosthetics
J1751	J1750	AHEC, ESRD, Hospital, Nurse Midwife, Nurse Practitioner, Physician
J1752	J1750	AHEC, ESRD, Hospital, Nurse Midwife, Nurse Practitioner, Physician
J1945	Q2021	Hospital
J7306	A4260	Physician, Family Planning, FQHC, Nurse Practitioner, AHEC, Hospital
L0621	K0630	Prosthetics
L0622	K0631	Prosthetics
L0623	K0632	Prosthetics
L0624	K0633	Prosthetics
L0625	K0634	Prosthetics
L0626	K0635	Prosthetics
L0627	K0636	Prosthetics
L0628	K0637	Prosthetics
L0629	K0638	Prosthetics
L0630	K0639	Prosthetics
L0631	K0640	Prosthetics
L0632	K0641	Prosthetics
L0633	K0642	Prosthetics
L0634	K0643	Prosthetics
L0635	K0644	Prosthetics
L0636	K0645	Prosthetics
L0637	K0646	Prosthetics
L0638	K0647	Prosthetics
L0639	K0648	Prosthetics
L0640	K0649	Prosthetics
L0859	L0860	Prosthetics

The following procedure codes are new non-covered codes that replace previously non-covered codes.

Replacement	Deleted	Replacement	Deleted	Replacement	Deleted
A6531	L8110	A6539	L8190	E2219	K0075
A6532	L8120	A6540	L8195	J1675	Q2020
A6533	L8130	A6541	L8200	L0491	K0618
A6534	L8140	A6542	L8210	L0492	K0619
A6535	L8150	A6543	L8220	L5858	K0670
A6536	L8160	A6544	L8230	L8623	K0731
A6537	L8170	E0170	E0169	L8624	K0732
A6538	L8180	E0171	E0169

XX.Non-Covered HCPCS Procedure Codes

The following procedure codes are not covered by Arkansas Medicaid.

A0998

A9698

G8011

G8036

G8082

G8152

G9041

G9071

G9096

G9121

L2034

L5858

L8688

Q0503

A4218

C9723

G8012

G8037

G8093

G8153

G9042

G9072

G9097

G9122

L2387

L5971

L8689

Q0504

A4233

C9724

G8013

G8038

G8094

G8154

G9043

G9073

G9098

G9123

L3671

L6621

Q0480

Q0505

A4234

C9725

G8014

G8039

G8099

G8155

G9044

G9074

G9099

G9124

L3672

L6677

Q0481

Q0510

A4235

E0170

G8015

G8040

G8100

G8156

G9050

G9075

G9100

G9125

L3673

L6883

Q0482

Q0511

A4236

E0171

G8016

G8041

G8103

G8157

G9051

G9076

G9101

G9126

L3702

L6884

Q0483

Q0512

A4363

E0172

G8017

G8051

G8104

G8158

G9052

G9077

G9102

G9127

L3763

L6885

Q0484

Q0513

A6531

E0485

G8018

G8052

G8106

G8159

G9053

G9078

G9103

G9128

L3764

L7400

Q0485

Q0514

A6532

E0486

G8019

G8053

G8107

G8160

G9054

G9079

G9104

G9129

L3765

L7401

Q0486

Q0515

A6533

E2216

G8020

G8054

G8108

G8161

G9055

G9080

G9105

G9130

L3766

L7402

Q0487

Q4080

A6534

E2217

G8021

G8055

G8109

G8162

G9056

G9081

G9106

J0365

L3905

L7403

Q0488

S0142

A6535

E2218

G8022

G8056

G8110

G8163

G9057

G9082

G9107

J1430

L3913

L7404

Q0489

S0143

A6536

E2219

G8023

G8057

G8111

G8164

G9058

G9083

G9108

J1675

L3919

L7405

Q0490

S0197

A6537

E2222

G8024

G8058

G8112

G8165

G9059

G9084

G9109

J3355

L3921

L7600

Q0491

S0265

A6538

E2223

G8025

G8059

G8113

G8166

G9060

G9085

G9110

J7620

L3933

L8609

Q0492

S0595

A6539

E2224

G8026

G8060

G8114

G8167

G9061

G9086

G9111

J7627

L3935

L8623

Q0493

S2078

A6540

E2225

G8027

G8061

G8115

G8170

G9062

G9087

G9112

J7640

L3961

L8624

Q0494

S3005

A6541

E2371

G8028

G8062

G8116

G8171

G9063

G9088

G9113

J8498

L3967

L8680

Q0495

S8270

A6542

G0333

G8029

G8075

G8117

G8172

G9064

G9089

G9114

J8515

L3971

L8681

Q0496

S8940

A6543

G0372

G8030

G8076

G8126

G8182

G9065

G9090

G9115

J8540

L3973

L8682

Q0497

V2788

A6544

G8006

G8031

G8077

G8127

G8183

G9066

G9091

G9116

J8597

L3975

L8683

Q0498

A9281

G8007

G8032

G8078

G8128

G8184

G9067

G9092

G9117

J9175

L3976

L8684

Q0499

A9282

G8008

G8033

G8079

G8129

G8185

G9068

G9093

G9118

K0730

L3977

L8685

Q0500

A9546

G8009

G8034

G8080

G8130

G8186

G9069

G9094

G9119

L0491

L3978

L8686

Q0501

A9566

G8010

G8035

G8081

G8131

G9033

G9070

G9095

G9120

L0492

L5703

L8687

Q0502

Please Note: Procedure code S2078 described as "Laparoscopic supracervical hysterectomy (subtotal hysterectomy), with or without removal of tubes(s), with or without removal of ovary(s)" is not covered by Arkansas

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

The following 2005 HCPCS procedure codes are not payable because these services are covered by another CPT procedure code, another HCPCS procedure code or by a revenue code.

A4411

A9275

E0762

E1812

G0376

J2850

Q9946

Q9950

Q9954

Q9958

Q9962

S0198

S2075

S2114

A4412

B4185

E0764

G0235

G0378

J3471

Q9947

Q9951

Q9955

Q9959

Q9963

S0613

S2076

S2117

A4604

E0641

E0912

G0332

G0379

J3472

Q9948

Q9952

Q9956

Q9960

Q9964

S0625

S2077

S2900

A6457

E0642

E1392

G0375

J2805

Q9945

Q9949

Q9953

Q9957

Q9961

S0133

S2068

S2079

S3626

S3854

If you need this material in an alternative format, such as large print, please contact our Americans with Disabilities Act Coordinator at (501) 682-6789 or 1-877-708 -8191. Both telephone numbers are voice and TDD.

If you have questions regarding this transmittal, please contact the EDS Provider Assistance Center at 1-800-457 -4454 (Toll-Free) within Arkansas or locally and Out-of-State at (501) 376-2211.

Arkansas Medicaid provider manuals (including update transmittals), official notices and remittance advice (RA) messages are available for downloading from the Arkansas Medicaid website: www.medicaid.state.ar.us.

Thank you for your participation in the Arkansas Medicaid Program.

___________________________________________________

Roy Jeffus, Director

016.06.06 Ark. Code R. § 014

5/5/2006