016.06.11 Ark. Code R. 019

Current through Register Vol. 49, No. 9, September, 2024

Rule 016.06.11-019 - Provider Manual Update Transmittal HOSPITAL-2-11

Section II Hospital/Critical Access Hospital (CAH)/End Stage Renal Disease (ESRD)

272.450Special Billing Requirements for Laboratory and X-Ray Services

The following table lists other services covered by Medicaid that are not restricted to the malignant neoplasm or HIV diagnoses:

Radiation Therapy
National Code	Required Modifier	Local Code Description
77417*	U2	Localization/verification - Film 1 port
77417*	U3	Localization/verification - Film 2 port
77417*	U1	Localization/verification - Film 3 port
77417*	U2	Localization/verification - Film 4 port

* Arkansas Medicaid Description

The following codes have special billing requirements for laboratory and X-ray procedures.

A. OPT and HCPCS Lab Procedure Codes with Diagnosis Restrictions

The following CPT and procedure codes will be payable with a primary diagnosis as is indicated below.

Procedure Code	Required Primary Diagnosis
83951	571.5
88720	227.4, 774.2,774.6, or 782.4
88740	986
88741	289.7 or 791.2

B. Genetic Testing

Procedure Code	Payment Method
S3831	Manually priced with no age or diagnosis restrictions
S3835
S3837
S3840
S3843
S3844
S3846
S3847
S3848
S3849

S3850
S3851
S3853
S3860
S3861
S3862
S3800	Manually priced with no age or diagnosis restrictions; requires Prior Authorization. This procedure code requires prior authorization by AFMC based on the following criteria: (1) an ICD-9-CM diagnosis code of 335.20 and symptoms of muscle weakness, (2) documentation of muscle testing must be provided and (3) a completed evaluation by a neurologist to rule out other causes of muscle weakness. (See Section 241.00 regarding procedures for obtaining prior authorization by AFMC.)

Procedure Code	Description
S3620	Newborn Metabolic Screening Panel

Arkansas Code § 20-15-302 states that all newborn infants shall be tested for phenylketonuria, hypothyroidism, galactosemia, cystic fibrosis and sickle cell anemia. Arkansas Medicaid shall reimburse the enrolled Arkansas Medicaid hospital provider that performs the tests required for the cost of the tests. Newborn Metabolic Screenings performed inpatient are included in the interim per diem reimbursement rate and facility cost settlement. For Newborn Metabolic Screenings performed in the outpatient setting (due to retesting or as an initial screening), Arkansas Medicaid will reimburse the hospital directly. For the screenings performed in the outpatient hospital setting, the provider will submit a claim using procedure code S3620. All positive test results shall be sent immediately to the Arkansas Department of Health.

016.06.11 Ark. Code R. 019

8/15/2011