ON-002-20 -- 2020 Current Procedural Terminology (CPT ...



OFFICIAL NOTICE

TO: Health Care Providers – All Providers

DATE: February 27, 2020

SUBJECT: 2020 Current Procedural Terminology (CPT®) Code Conversion

I. General Information

A review of the 2020 Current Procedural Terminology (CPT®) procedure codes has been completed, and the Arkansas Medicaid Program will begin accepting CPT® 2020 procedure codes for dates of service on and after January 1, 2020. Any claim adjustments needed due to coding changes will be the responsibility of the provider. Requests for PA revisions should be submitted by the provider to the approving entity. All claims submissions and adjustments should be received prior to the 365-day filing deadline.

Procedure codes that are identified as deletions in CPT® 2020 (Appendix B) are non-payable for dates of service on and after January 1, 2020.

For the benefit of those programs impacted by the conversions, the Arkansas Medicaid website fee schedules will be updated soon after the implementation of the 2020 CPT® and Healthcare Common Procedure Coding System Level II (HCPCS) conversions.

II. Process for Obtaining Prior Authorization

When obtaining a Prior Authorization from the Arkansas Foundation for Medical Care and eQHealth Solutions - Arkansas Division, please send your request to the following:

|Arkansas Foundation for Medical Care |

|In-state and out-of-state toll free for |1-800-426-2234 |

|inpatient reviews, Prior Authorizations for | |

|surgical procedures and assistant surgeons only| |

|General telephone contact, local or long |(479) 649-8501 |

|distance – Fort Smith |1-877-650-2362 |

|Fax for Molecular Pathology only |(479) 649-9413 |

|Fax – General |(479) 649-0799 |

|Fax – Physician Drug Reviews Only (PDR) |(501) 212-8663 |

|Web portal – AFMC | |

|Web portal – Arkansas Medicaid | |

|Mailing address |Arkansas Foundation for Medical Care, Inc. |

| |P.O. Box 180001 |

| |Fort Smith, AR 72918-0001 |

|Physical site location |5111 Rogers Avenue, Suite 476 |

| |Fort Smith, AR 72903 |

|Office hours |8:00 a.m. until 4:30 p.m. (Central Time), Monday through Friday, except holidays |

|eQHealth Solutions - Arkansas Division |

|Adult Behavioral Health Services for Community Independence |eQHealth Solutions - Arkansas Division |

|Adult Development Day Treatment (ADDT) |200 W. Capitol Ave, Ste. 610 |

|Early Intervention Day Treatment (EIDT) |Little Rock, AR 72201 |

|Outpatient Behavioral Health Services (OBHS) | |

|Occupational, Physical, and Speech Therapy Service |Office Hours: Monday - Friday (except Holidays) |

|Child Health Services/Early and Periodic Screening, |8:00am - 5:00pm (CST) |

|Diagnosis and Treatment (EPSDT) |Arkansas Customer Service Line |

| |1-501-725-9411 (Main Line) |

| |1-888-660-3831 |

| |Arkansas Provider Fax Line |

| |1-855-997-3707 (toll-free fax) |

| |Provider Education and Outreach |

| |Ar.pr@ |

| |eQHealth Solutions - Corporate Office |

| |8440 Jefferson Highway, Suite 101 |

| |Baton Rouge, LA 70809 |

| |1-800-720-2578 |

| |Submit PA request electronically |

| | |

III. CPT Procedure Codes Payable to Hospitals

The following 2020 CPT Procedure Codes are payable to Hospital Providers:

|15769 |20560 |20561 |21601 |21602 |21603 |

|33016 |33017 |33018* |33019 |35702 |35703 |

|46948 |62328 |62329 |64451 |66987 |66988 |

|74221 |78429 |78430 |78431 |78432 |78433 |

|78830 |78831 |78832 |80145 |80187 |80230 |

|80235 |80280 |80285 |81307* |81308* |81309* |

|81522* |87563 |90619 |92549 |95700 |95705 |

|95706 |95707 |95708 |95709 |95710 |95711 |

|95712 |95713 |95714 |95715 |95716 |95717 |

|95718 |95719 |95720 |95721 |95722 |95723 |

|95724 |95725 |95726 |0153U* |0154U* |0155U* |

|0548T |0549T |0550T |0551T | | |

* Procedure code is on medical review

IV. CPT Procedure Codes Payable to Physicians and Area Health Education

Centers (AHECs)

The following information is related to procedure codes payable to Physician and AHEC Providers:

|15769 |20560 |20561 |20700 |20701 |20702 |

|20703 |20704 |20705 |21601 |21602 |21603 |

|33016 |33017 |33018* |33019 |33858 |33859 |

|33871 |34717 |34718 |35702 |35703 |46948 |

|49013* |49014 |62328 |62329 |64451 |66987 |

|66988 |90619 |92202 |92549 |93985 |93986 |

|95700 |95705 |95706 |95707 |95708 |95709 |

|95710 |95711 |95712 |95713 |95714 |95715 |

|95716 |95717 |95718 |95719 |95720 |95721 |

|95722 |95723 |95724 |95725 |95726 |0548T |

|0549T |0550T |0551T | | | |

* Procedure code is on medical review

V. Nurse Practitioner

The payment for Laboratory codes listed on the Nurse Practitioner Fee Schedule is based on Clinical Laboratory Improvement Amendments (C.L.I.A.) certification. Note that only C.L.I.A.-certified providers may bill for lab procedures performed in the provider’s office, place of service (11). Nurse Practitioner Providers that bill C.L.I.A.-required Laboratory procedure codes must have the current C.L.I.A. certification on file with the Arkansas Medicaid Provider Enrollment Unit.

The technical component of Radiology procedure codes listed on the Nurse Practitioner Fee Schedule is payable when performed in the office place of service (11) if the Nurse Practitioner Provider owns the equipment. The technical component must be billed on the claim with modifier TC added to the procedure code on the claim detail.

A. The following 2020 CPT® procedure codes are payable to Nurse Practitioner Providers:

|90619 | | | | | |

B. Surgical Codes payable to Nurse Practitioners

|20700 |20701 |20702 |20703 |20704 |20705 |

VI. Laboratory

The following 2020 CPT® procedure codes are payable to Laboratory Providers.

|80145 |80187 |80230 |80235 |80280 |

|80285 |81307* |81308* |81309* |81522* |

|87563 |0153U* |0154U* |0155U* |0157U* |

|0158U* |0159U* |0160U* |0161U* |0162U* |

* Procedure code is on medical review

VII. Radiology

The following 2020 CPT® procedure codes are payable to Radiology Providers.

|74221 |74248 |78429 |78430 |78431 |

|78432 |78433 |78434 |78830 |78831 |

|78832 |78835 |95717 |95718 |95719 |

|95720 |95721 |95722 |95723 |95724 |

|95725 |95726 | | | |

VIII. Pharmacy

The following 2020 CPT® procedure codes are payable to Pharmacy Providers.

|90619 | | | | |

IX. Podiatry

The following 2020 CPT® procedure codes are payable to Podiatry Providers.

|20560 |20561 | | | |

X. Vision

The following 2020 CPT® procedure codes are payable to Vision Providers.

|92201 |92202 | | | |

XI. Ambulatory Surgical Center (ASC)

The 2020 Medicare ASC Fee Schedule has been implemented into the Arkansas Medicaid ASC program retroactive to dates of service January 1, 2020. An updated fee schedule will be available soon.

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

If you need this material in an alternative format, such as large print, please contact the Office of Rules Promulgation at (501) 320-6266.

Arkansas Medicaid provider manuals (including update transmittals), official notices, notices of rule making, and remittance advice (RA) messages are available for download from the Arkansas Medicaid website: .

Thank you for your participation in the Arkansas Medicaid Program.

/s/ Janet Mann

Janet Mann

Director

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