016-06-06 Ark. Code R. § 27
Place of Service | Paper Claims | Electronic Claims |
Inpatient Hospital | 1 | 21 |
Outpatient Hospital | 2 | 22 |
Doctor's Office | 3 | 11 |
Patient's Home | 4 | 12 |
Day Care Facility | 5 | 52 |
Night Care Facility | 6 | 52 |
Nursing Facility | 7 | 32 |
Skilled Nursing Facility | 8 | 31 |
Ambulance | 9 | 41 |
Other Locations | 0 | 99 |
Independent Laboratory | A | 81 |
Ambulatory Surgical Center | B | 24 |
Residential Treatment Center | C | 56 |
Specialized Treatment Facility | D | 56 |
Comprehensive Outpatient Rehabilitative Facility | E | 62 |
Independent Kidney Disease Treatment Center | F | 65 |
Inpatient Psychiatric Facility | G | 51 |
Type of Service (paper only) |
H-Over 21 |
U-Used Equipment |
I-Initial Rental |
6-Under 21 |
Modifiers |
EP- Service provided as part of EPSDT Program |
KH-Durable Medical Equipment (DME) item, initial claim, first month's rental |
NU-New Equipment |
RR-Durable Medical Equipment (DME) Rental |
U1-Medicaid Level of Care 1 (defined by state) |
U2-Medicaid level of Care 2 (defined by state) |
U3-Medicaid level of care 3 (defined by state) |
Modifiers |
U4-Medicaid level of care 4 (defined by state) |
U5-Medicaid level of care 5 (defined by state) |
UE-Used durable medical equipment (DME) |
52-Reduced Services |
Certified Nurse-Midwife
Place of Service | Paper Claims | Electronic Claims |
Inpatient Hospital | 1 | 21 |
Outpatient Hospital | 2 | 22 |
Doctor's Office | 3 | 11 |
Patient's Home | 4 | 12 |
Nursing Facility | 7 | 32 |
Skilled Nursing Facility | 8 | 31 |
Other Locations | 0 | 99 |
Independent Laboratory | A | 81 |
Ambulatory Surgical Center | B | 24 |
Specialized Treatment Facility or Federally Qualified Health Center (FQHC) | D | 56 |
Emergency Department for Emergency Services | X | 23 |
Type of Service (paper only) |
9 - Certified Nurse- Midwife |
A - Family Planning |
016.06.06 Ark. Code R. § 027