016.06.07 Ark. Code R. 001

Current through Register Vol. 49, No. 10, October, 2024

Rule 016.06.07-001 - 2007 HCPCS & CPT Procedure Code Conversion Official Notices

I.General Information

A review of the 2007 CPT procedure codes has been completed, and the Arkansas Medicaid Program will begin accepting CPT 2007 procedure codes for dates of service on and after March 1, 2007. Please add this information to your Medicaid provider manual until revised manual sections have been included in future updates.

Procedure codes that are identified as deletions in the CPT 2007 (Appendix B) are non-payable for dates of service on and after March 1, 2007.

II.Non-Covered CPT 2007 Procedure Codes

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

22526	22527	43647	43648	43881	43882	58541
58542	58543	58544	70554	70555	94002	94003
94004	94005	94774	94775	94776	94777	96020
96040	99363	99364

B. All CPT 2007 procedure codes listed in Category II and Category III are non-covered.

C. Effective for dates of service on and after March 1, 2007, the following new 2007 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.

15003	15005	15847	17312	17314
17315	35306	49326	49435	94645

III.Prior Authorization

The following 2007 CPT procedure codes require prior authorization (PA).

15830

15847

76813

76814

IV.CPT 2007 Procedure Codes Manually Reviewed

Effective for dates of service on and after March 1, 2007, the CPT procedure codes listed below are manually reviewed before payment. Providers must submit paper claims with supporting documentation.

37210

58548

91111

V.Podiatry Program

The following CPT 2007 procedure codes are payable to podiatry providers.

15002	15003	15004	15005
17311	17312	17315

VI.Oral Surgery Program

The following CPT 2007 procedure codes are payable to oral surgeons.

15004

15005

17311

17312

17315

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 (TDD only)

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, or. us.

Roy Jeffus, Director

I.General Information

A review of the 2007 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, 2007.

II.2007 HCPCS Payable Procedure Code Tables Information

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

The tables of payable procedure codes 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. The procedure code may be shown on multiple lines of the table, 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 by some provider types. 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.

Certain procedure codes are covered only when the primary diagnosis is covered within a specific diagnosis range. This information is used, for example, by physicians, hospitals and others. The fourth and fifth columns indicate the beginning and ending range of diagnoses for which a procedure code may be used, (e.g.: 0530 through 0549).

The sixth column indicates whether a procedure is subject to 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 seventh 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" indicates that 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 eighth column indicates any modifiers that must be used in conjunction with the procedure code, when billed, either electronically or on paper.

The ninth column indicates which procedure code requires a "prior approval letter" from the Arkansas Medicaid Medical Director. The letter "Y" in the column indicates that a procedure code requires a prior approval letter and an "N" indicates that a prior approval letter is not required. A prior approval letter, when required, must be attached to the paper claim when it is filed.

III.HCPCS Procedure Codes Payable to ARKids

2007 Codes

TOS

Manually Priced

Y/N

Beginning

Diagnosis

Range

Ending

Diagnosis

Range

Review Y/N

Y/N

Modifier

Prior

Approval

Letter

Y/N

E0936

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

The following information is related to procedure codes found in the ASC table. Reference the superscript alpha character following the procedure code in the table to determine what coverage protocol applies to that procedure code in the grid.

^JJ7319 Prior authorization must be obtained through the Utilization

Review Section of the Division of Medical Services (DMS). Providers must specify the brand name of Hyaluronon or derivative when requesting prior authorization for this procedure code. A written request must be submitted to the Division of Medical Services Utilization Review Section.

The request must include the patient's name, Medicaid ID number, physician's name, Physician's Medicaid provider number and medical records that document the severity of osteoarthritis, previous treatments and site of injection. Hyaluronon is limited to one series of injections per knee, per beneficiary, per lifetime.

The contact information for Utilization Review is:

In-State WATS:

Direct: (501) 682-8340

Voice Mail: 1-800-482 -1141

FAX: (501) 682-8013

Mailing Arkansas Division of Medical Services Utilization

Review Section Address: P. O. Box 1437, Slot S413

Little Rock, AR 72203-1437

2007 Codes

TOS

Manually Priced

Y/N

Beginning

Diagnosis

Range

Ending

Diagnosis

Range

Review Y/N

Y/N

Modifier

Prior

Approval

Letter

(Y/N)

J7319^J

S2344

V.HCPCS Procedure Codes Payable to Family Planning Clinic

Family planning services require a family planning detail diagnosis code.

The following information is related to procedure codes found in the family planning clinic table. Reference the superscript alpha character following the procedure code in the table to determine what coverage protocol applies to that procedure code in the grid. A family planning diagnosis code is required.

^N SO 180 This procedure code is covered as a family planning benefit for

"regular Medicaid" beneficiaries. It is not covered for aid category 69 beneficiaries. It is benefit limited to two per seven years per beneficiary.

2007 Codes

TOS

Manually Priced

Y/N

Beginning

Diagnosis

Range

Ending

Diagnosis

Range

Review Y/N

Y/N

Modifier

Prior

Approval

Letter

(Y/N)

S0180^N

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

Family planning services require a family planning detail diagnosis code.

The following information is related to procedure codes found in the FQHC table. Reference the superscript alpha character following the procedure code in the table to determine what coverage protocol applies to that procedure code in the grid. A primary family planning diagnosis code is required.

^N SO 180 This procedure code is covered as a family planning benefit for

"regular Medicaid" beneficiaries. It is not covered for aid category 69 beneficiaries. It is benefit limited to two per seven years per beneficiary.

2007 Codes

TOS

Manually Priced

Y/N

Beginning

Diagnosis

Range

Ending

Diagnosis

Range

Review Y/N

Y/N

Modifier

Prior

Approval

Letter

Y/N

S0180^N

VII.HCPCS Procedure Codes Payable to Hemodialysis Providers

2007 Codes

TOS

Manually Priced

Y/N

Beginning

Diagnosis

Range

Ending

Diagnosis

Range

Review Y/N

Y/N

Modifier

Prior

Approval

Letter

Y/N

Q4081

584

586

VIII.HCPCS Procedure Codes Payable to Home Health

2007 Codes

TOS

Manually Priced

Y/N

Beginning

Diagnosis

Range

Ending

Diagnosis

Range

Review Y/N

Y/N

Modifier

Prior

Approval

Letter

Y/N

T4543

IX.HCPCS Procedure Codes Payable to Hospitals

The following information is related to procedure codes found in the hospital table. Reference the superscript alpha character following the procedure code in the table to determine what coverage protocol applies to that procedure code in the grid.

C9232 This procedure code requires an ICD-9-CM diagnosis code of

277.5 (MPSII) . An evaluation by a physician with a specialty in clinical genetics, documenting progress is required annually. A prior approval letter from the DMS Medical Director is required for billing, and a copy must be attached to each claim. Review the appropriate provider manual for additional coverage information and instructions or contact the DMS Medical Director at (501)-682-9868.

C9233 This procedure code requires an ICD-9-CM diagnosis code of

362.50 or 362.52 as the principle diagnosis. A prior approval letter from the DMS Medical Director is required for billing and a copy must be attached to each claim. Review the appropriate provider manual for additional coverage information and instructions for requesting prior approval or contact the DMS Medical Director at (501)-682-9868.

C9235 This procedure code requires an ICD-9-CM diagnosis code of

153.0-154.8. A prior approval letter from the DMS Medical Director is required for billing and must be attached to each claim. A copy of the prior approval letter must be attached to each claim. Review the appropriate provider manual for additional coverage information and instructions for requesting prior approval or contact the DMS Medical Director at (501)-682-9868.

C9350 This procedure code requires attachment of manufacturer's invoice and procedure report to the claim.

^E J0129 This procedure code requires an ICD-9-CM diagnosis code of

714.0-714.2 as a primary diagnosis. The patient must have had an inadequate response to one or more Disease-Modifying Anti-Rheumatic Drugs, such as methotrexate or Tumor Necrosis Factor antagonists (Humira, Remicade, etc.). The records submitted must include a history and physical exam showing (1) the severity of the rheumatoid arthritis (2) Treatment with one of the above listed drugs (3) treatment failure resulting in progression of joint destruction, swelling, or tendonitis, etc. A prior approval letter from the DMS Medical Director is required for billing and a copy must be attached to each claim. Review the appropriate provider manual for additional coverage information and instructions for requesting prior approval or contact the DMS Medical Director at (501)-682-9868.

^FJ0348 This procedure code is covered for any of the conditions below,

along with an ICD-9-CM diagnosis code of 112.5 or 112.8 (and any valid 5^th digits), or 112.9.

(1) Endstage Renal Disease (ICD-9-CM diagnosis codes, 584 through 586).

(2) AIDS or cancer (ICD-9-CM diagnosis codes 042, 140.0-208.9) OR

(3) Post transplant status (i.e., ICD-9 CM diagnosis code 986.80-996.89) or specify transplanted organ and transplant date.

^GJ0894 This procedure code requires ICD-9-CM diagnosis codes of

205. 00-205.91, 238.72, 238.74, 238.75, or 281.3. A prior approval letter from the DMS Medical Director is required for billing and a copy must be attached to each claim. Review the appropriate provider manual for additional coverage information and instructions for requesting prior approval or contact the DMS Medical Director at (501)-682-9868.

^HJ1458 This procedure code requires an ICD-9-CM diagnosis code of

277.5 (MPSVI) . An evaluation by a physician with a specialty in clinical genetics documenting progress is required annually. A prior approval letter from the DMS Medical Director is required for billing and a copy must be attached to each claim. Review the appropriate provider manual for additional coverage information and instructions for requesting prior approval or contact the DMS Medical Director at (501)-682-9868.

¹ J7311 This procedure code requires an ICD-9-CM diagnosis code of

363.20. Only indications and age ranges approved by the FDA will be considered. Each request will be reviewed on a case by case basis. An evaluation by an ophthalmologist documenting failure of all other treatments and the complication of all current treatments must be clearly documented. Complications that will lead to blindness must be clearly stated. A prior approval letter from the DMS Medical Director is required for billing and a copy must be attached to each claim. Review the appropriate provider manual for additional coverage information and instructions for requesting prior approval or contact the DMS Medical Director at (501)-682-9868.

^JJ7319 Prior authorization must be obtained through the Utilization

The request must include the patient's name, Medicaid ID number, physician's name, Physician's Medicaid provider number and medical records that document the severity of osteoarthritis, previous treatments, and site of injection. Hyaluronon is limited to one series of injections per knee, per beneficiary, per lifetime.

The contact information for Utilization Review is:

In-State WATS:

Direct: (501) 682-8340

Voice Mail: 1-800-482 -1141

FAX: (501) 682-8013

Mailing Arkansas Division of Medical Services Utilization

Review Section Address: P. O. Box 1437, Slot S413

Little Rock, AR 72203-1437

^KJ7346 This procedure code requires submission of operative report with claim.

^L J9261 This procedure code requires ICD-9-CM diagnosis codes of

202.80-202.89 or 204.0-208.90. The disease must have not responded to or either has relapsed following treatment with at least two chemotherapy regimens. A prior approval letter from the DMS Medical Director is required for billing and a copy must be attached to each claim. Review the appropriate provider manual for additional coverage information and instructions for requesting prior approval or contact the DMS Medical Director at (501)-682-9868.

^M SO 147 This procedure code requires an ICD-9-CM diagnosis code of

271.0. An evaluation by a physician with a specialty in clinical genetics documenting progress is required annually. A prior approval letter from the DMS Medical Director is required for billing and a copy must be attached to each claim. Review the appropriate provider manual for additional coverage information and instructions for requesting prior approval or contact the DMS Medical Director at (501)-682-9868.

^N SO 180 This procedure code is covered as a family planning benefit for

"regular Medicaid" beneficiaries. It is not covered for aid category 69 beneficiaries. It is benefit limited to two per seven years per beneficiary. A primary family planning diagnosis is required.

2007 Codes	TOS	Manually Priced Y/N	Beginning Diagnosis Range	Ending Diagnosis Range	Review Y/N	PA Y/N	Modifier	Prior Approval Letter Y/N
A9527	Y	N	N	N
A9568	Y	N	N	N
C9232*	N	2775	2775	Y	N	Y
C9233^B	N	Y	N	Y
C9235^c	N	Y	N	Y
C9350^D	Y	N	N	N
J0129^E	N	Y	N	Y
J0348^F	N	Y	N	N
J0364	N	N	N	N
J0594	N	N	N	N
J0894^G	N	Y	N	Y
J1324	Y	N	N	N
J1458^H	N	Y	N	Y
J1562	Y	N	N	N
J1740	N	N	N	N
J2248	N	N	N	N
J3243	N	N	N	N
J3473	N	N	N	N
J7187	N	N	N	N
J7311¹	N	Y	N	Y
J7319^J	Y	M	Y	N
J7345	N	N	N	N
J7346^K	N	Y	N	N
J8650	Y	N	N	N
J9261^L	N	Y	N	Y
Q4081	N	584	586	N	N	N
S0147^M	Y	Y	NT	Y
S0180^N	Y	N	N	N
S2344	Y	N	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.

2007 Codes

TOS

Manually Priced

Y/N

Beginning

Diagnosis

Range

Ending

Diagnosis

Range

Review Y/N

Y/N

Modifier

Prior

Approval

Letter

Y/N

A9527

A9568

XI.HCPCS Procedure Codes Payable to Oral Surgeons

The following information is related to procedure codes found in the oral surgeon section table. Reference the superscript alpha character following the procedure code in the table to determine what coverage protocol applies to that procedure code in the grid.

^DC9350 This procedure code requires attachment of manufacturer's invoice and procedure report to the claim.

^KJ7346 This procedure code requires submission of operative report with claim.

2007 Codes	TOS	Manually Priced Y/N	Beginning Diagnosis Range	Ending Diagnosis Range	Review Y/N	PA Y/N	Modifier	Prior Approval Letter Y/N
C9350^D	1	Y	N	N	N
J7345	1	N	N	N	N
J7346^K	1	N	Y	N	N

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

The following information is related to procedure codes found in the physicians and AHECs section table. Reference the superscript alpha character following the procedure code in the table to determine what coverage protocol applies to that procedure code in the grid.

^AC9232 This procedure code requires an ICD-9-CM diagnosis code of

^BC9233 This procedure code requires an ICD-9-CM diagnosis code of

^cC9235 This procedure code requires an ICD-9-CM diagnosis code of

^DC9350 This procedure code requires attachment of manufacturer's invoice and procedure report to the claim.

^E J0129 This procedure code requires an ICD-9-CM diagnosis code of

^FJ0348 This procedure code is covered for any of the conditions below,

along with an ICD-9-CM diagnosis code of 112.5 or 112.8 (and any valid 5^th digits), or 112.9.

(1) Endstage Renal Disease (ICD-9-CM diagnosis codes, 584 through 586)

(2) AIDS or cancer (ICD-9-CM diagnosis codes 042, 140.0-208.9) OR

(3) Post transplant status (i.e., ICD-9 CM diagnosis code 986.80-996.89) or specify transplanted organ and transplant date.

^GJ0894 This procedure code requires ICD-9-CM diagnosis codes of

^HJ1458 This procedure code requires an ICD-9-CM diagnosis code of

^J J7319 Prior authorization must be obtained through the Utilization

The request must include the patient's name, Medicaid ID number, physician's name, Physician's Medicaid provider number and medical records that document the severity of osteoarthritis, previous treatment and site of injection. Hyaluronon is limited to one series of injections per knee, per beneficiary, per lifetime.

The contact information for Utilization Review is:

In-State WATS:

Direct: (501) 682-8340

Voice Mail: 1-800-482 -1141

FAX: (501) 682-8013

Mailing Arkansas Division of Medical Services Utilization

Review Section Address: P. O. Box 1437, Slot S413

Little Rock, AR 72203-1437

^KJ7346 This procedure code requires submission of operative report with claim.

^LJ9261 This procedure code requires ICD-9-CM diagnosis codes of

^M SO 147 This procedure code requires an ICD-9-CM diagnosis code of

^N SO 180 This procedure code is covered as a family planning benefit for

"regular Medicaid" beneficiaries. It is not covered for aid category 69 beneficiaries. It is benefit limited to two per seven years per beneficiary. A primary family planning diagnosis is required.

2007 Codes	TOS	Manually Priced Y/N	Beginning Diagnosis Range	Ending Diagnosis Range	Review Y/N	PA Y/N	Modifier	Prior Approval Letter Y/N
A9527	Y	N	N	N
A9568	Y	N	N	N
C9232*	N	2775	2775	Y	N	Y
C9233^B	N	Y	N	Y
C9235^c	N	Y	N	Y
C9350^D	Y	N	N	N
J0129^E	N	Y	N	Y
J0348^F	N	Y	N	N
J0364	N	N	N	N
J0594	N	N	N	N
J0894^G	N	Y	N	Y
J1324	Y	N	N	N
J1458^H	N	Y	N	Y
J1562	Y	N	N	N
J1740	N	N	N	N
J2248	N	N	N	N
J3243	N	N	N	N
J3473	N	N	N	N
J7187	N	N	N	N
J7319^J	Y	N	Y	N
J7345	N	N	N	N
J7346^K	N	Y	N	N
J8650	Y	N	N	N
J9261^L	N	Y	N	Y
Q4081	N	584	586	N	N	N
S0147^M	Y	Y	N	Y
S0180^N	A	Y	N	N	FP	N
S2344	2	Y	N	N	N
S2344	8	Y	N	Y	N

XIII.HCPCS Procedure Codes Payable to Prosthetics

** Prior authorization is not required when other insurance pays at least

50% of the Medicaid maximum allowable reimbursement amount.

^# The purchase of this wheelchair component is limited to one per five-year period for individuals age 21 and older.

⁺ Limited to one per 12 months.

2007 Codes	TOS	Manually Priced Y/N	Beginning Diagnosis Range	Ending Diagnosis Range	Review Y/N	PA Y/N	Modifier	Prior Approval Letter Y/N
A8000	H	N	N	N	N
A8000	6	N	N	N	EP	N
A8001	H	N	N	N	N
A8001	6	N	N	N	EP	N
E0936	H	Y	N	Y"	N
E0936	6	Y	N	Y"	EP	N
E2373	H	N	N	Y	N
E2373	6	N	N	Y	EP	N
E2375	H	N	N	Y	N
E2375	6	N	N	Y	EP	N
E2376	H	N	N	Y	N
E2376	6	N	N	Y	EP	N
E2377	H	N	N	Y	N
E2377	6	N	N	Y	EP	N
E2381	H	N	N	Y	N
E2381	6	N	N	Y	EP	N
E2382	H	N	N	Y	N
E2382	6	N	N	Y	EP	N
E2383	H	N	Y	N
E2383	6	N	N	Y	EP	N
E2384	H	N	N	Y	N
E2384	6	N	N	Y	EP	N
E2385	H	N	N	Y	N
E2385	6	N	N	Y	EP	N
E2386	H	N	N	Y	N
E2386	6	N	N	Y	EP	N
E2387	H	N	N	Y	N
E2387	6	N	N	Y	EP	N
L3915⁺	H	Y	N	N	N
L3915	6	Y	N	N	EP	N
L6624	H	Y	N	Y	N
L6624	6	Y	N	N	EP	N
L6703*	H	N	N	N	N
L6703	6	N	N	N	EP	N
L6704*	H	N	N	N	N
L6704	6	N	N	N	EP	N
L6706*	H	N	N	N	N
L6706	6	N	N	N	EP	N
L6707*	H	N	N	N	N
L6707	6	N	N	N	EP	N
L6708*	H	N	N	N	N
L6708	6	N	N	N	EP	N
L6709*	H	N	N	N	N
L6709	6	N	N	N	EP	N
L7007*	H	N	N	Y	N
L7007	6	N	N	N	EP	N
L7008	H	N	N	Y	N
L7008*	6	N	N	N	EP	N
L7009	H	N	N	Y	N
L7009	6	N	N	N	EP	N
T4543	H	N	N	N	N

NOTE: Procedure codes L7007 and L7008 are for replacement only.

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

The following 2007 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.

C1820

G0389

K0807

K0820

K0826

K0835

K0841

K0851

K0857

K0863

K0877

K0886

Q5004

C1821

G0390

K0808

K0821

K0827

K0836

K0842

K0852

K0858

K0864

K0878

K0890

Q5005

C9234

G0392

K0813

K0822

K0828

K0837

K0843

K0853

K0859

K0868

K0879

K0891

Q5006

C9351

G0393

K0814

K0823

K0829

K0838

K0848

K0854

K0860

K0869

K0880

Q5001

Q5007

C9726

G0394

K0815

K0824

K0830

K0839

K0849

K0855

K0861

K0870

K0884

Q5002

S2325

D1555

K0806

K0816

K0825

K0831

K0840

K0850

K0856

K0862

K0871

K0885

Q5003

S3855

XV.Non-Payable HCPCS Procedure Codes for the ARKids First-B Program

A8000	E2383	E2392	K0737	K0813	K0825	K0837	K0850	K0859	K0871	K0891	L6708
A8001	E2384	E2393	K0738	K0814	K0826	K0838	K0851	K0860	K0877	K0898	L6709
E2373	E2385	E2394	K0800	K0815	K0827	K0839	K0852	K0861	K0878	K0899	L7007
E2374	E2386	E2395	K0801	K0816	K0828	K0840	K0853	K0862	K0879	L3915	L7008
E2375	E2387	E2396	K0802	K0820	K0829	K0841	K0854	K0863	K0880	L6624	L7009
E2376	E2388	K0733	K0806	K0821	K0830	K0842	K0855	K0864	K0884	L6703	T4543
E2377	E2389	K0734	K0807	K0822	K0831	K0843	K0856	K0868	K0885	L6704
E2381	E2390	K0735	K0808	K0823	K0835	K0848	K0857	K0869	K0886	L6706
E2382	E2391	K0736	K0812	K0824	K0836	K0849	K0858	K0870	K0890	L6707

XVI.Non-Covered HCPCS Procedure Codes

The following procedure codes are not covered by Arkansas Medicaid.

A4461

D1206

E2393

G8202

G8223

G8246

G8267

G8288

G8309

G8330

G9134

J7670

L8690

A4463

D4230

E2394

G8203

G8224

G8247

G8268

G8289

G8310

G8331

G9135

J7685

L8691

A4559

D4231

E2395

G8204

G8225

G8248

G8269

G8290

G8311

G8332

G9136

K0733

L8695

A4600

D6012

E2396

G8205

G8226

G8249

G8270

G8291

G8312

G8333

G9137

K0734

Q4082

A4601

D6091

G0380

G8206

G8227

G8250

G8271

G8292

G8313

G8334

G9138

K0735

Q5008

A8002

D6092

G0381

G8207

G8228

G8251

G8272

G8293

G8314

G8335

G9139

K0736

Q5009

A8003

D6093

G0382

G8208

G8229

G8252

G8273

88294

G8315

G8336

H0049

K0737

S0345

A8004

D7292

G0383

G8209

G8230

G8253

G8274

G8295

G8316

G8337

H0050

K0738

S0346

A9279

D7293

G0384

G8210

G8231

G8254

G8275

G8296

G8317

G8338

J2170

K0800

S0347

C9227

D7294

G8085

G8211

G8232

G8255

G8276

G8297

G8318

G8339

J2315

K0801

C9228

D7951

G8191

G8212

G8234

G8256

G8277

G8298

G8319

G8340

J7607

K0802

C9229

D7998

G8192

G8213

G8235

G8257

G8278

G8299

G8320

G8341

J7609

K0812

C9230

D8693

G8193

G8214

G8236

G8258

G8279

G8300

G8321

G8342

J7610

K0898

C9231

D9612

G8194

G8215

G8237

G8259

G8280

G8301

G8322

G8343

J7615

K0899

C9727

E0676

G8195

G8216

G8238

G8260

G8281

G8302

G8323

G8344

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L1001

D0145

E2374

G8196

G8217

G8239

G8261

G8282

G8303

G8324

G8345

J7645

L3806

D0273

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G8197

G8218

G8240

G8262

G8283

G8304

G8325

G8346

J7647

L3808

D0360

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G8198

G8219

G8241

G8263

G8284

G8305

G8326

G8347

J7650

L5993

D0362

E2390

G8199

G8220

G8242

G8264

G8285

G8306

G8327

G9131

J7657

L5994

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G8200

G8221

G8243

G8265

G8286

G8307

G8328

G9132

J7660

L6611

D0486

E2392

G8201

G8222

G8245

G8266

G8287

G8308

G8329

G9133

J7667

L6639

Paper versions of this update transmittal have updated pages attached to file in your provider manual. See Section I for instructions on updating the paper version of the manual. For electronic versions, these changes have already been incorporated.

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 (TDD only).

If you have questions regarding this transmittal, please contact the EDS Provider Assistance Center at 1-800-457 -4454 (Toil-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

016.06.07 Ark. Code R. 001

2/28/2007