Official Notice ON-001-19 HCPCS Codes



OFFICIAL NOTICE

TO: Health Care Providers – All Providers

DATE: March 26, 2019

SUBJECT: 2019 Healthcare Common Procedure Coding System Level II (HCPCS) Code Conversion and Code on Dental Procedures and Nomenclature (CDT) Conversion

I. General Information

A review of the 2019 HCPCS procedure codes has been completed, and the Arkansas Medicaid Program will begin accepting updated Healthcare Common Procedure Coding System Level II (HCPCS) procedure codes on claims with dates of service on and after January 1, 2019. 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.

Drug procedure codes require National Drug Code (NDC) billing protocol. Drug procedure codes that represent radiopharmaceuticals, vaccines and allergen immunotherapy are exempt from the NDC billing protocol.

Procedure codes that are identified as deletions in 2019 HCPCS Level II and 2019 Current Dental Terminology (CDT) will become non-payable for dates of service on and after January 1, 2019.

Please NOTE: The Arkansas Medicaid website fee schedules will be updated soon after the implementation of the 2019 Current Procedural Terminology (CPT) and HCPCS conversions.

II. 2019 HCPCS Payable Procedure Codes Tables Information

Procedure codes are in separate tables. Tables are created for each affected provider type (i.e., Prosthetics, Home Health, etc.).

The tables of payable procedure codes for all affected programs are designed with three columns of information. All columns may not be applicable for each covered program, but are devised for ease of reference.

Please NOTE: An asterisk indicates that the procedure code requires a paper claim.

1. The first column of the list contains the HCPCS procedure codes. The procedure code may be on multiple lines on the table, depending on the applicable modifier(s) based on the service performed.

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

3. The third column indicates that the coverage of the procedure code is restricted based on the beneficiary’s age.

III. Contact Information 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 |

|Autism Waiver |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 |

| | |

IV. International Classification of Diseases, 10th Revision, Clinical Modification

(ICD-10-CM), Diagnosis Range and Diagnosis Lists

Diagnosis is documented using the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM). Certain codes are covered only for a specific primary diagnosis or a particular diagnosis range.

V. ADA (American Dental Association) Dental

The following ADA (American Dental Association) procedure codes are payable to Dental Providers:

|D1516 |D1517 |D1526 |D1527 |

B. The following Dental Association procedure codes are non-payable:

|D0412 |D5281 |D5282 |D5283 |D5876 |

|D7283 |D9130 |D9613 |D9944 |D9945 |

|D9946 |D9961 |D9990 | | |

VI. HCPCS Procedure Codes Payable to Hearing Providers

The following 2019 HCPCS Procedure Codes are payable to Hearing Providers:

|V5171 |V5172 |V5181 |V5211 |V5212 |

|V5213 |V5214 |V5215 |V5221 | |

VII. HCPCS Procedure Codes Payable to Home Health

The following 2019 HCPCS Procedure Codes are payable to Home Health Providers:

|Procedure Code |Modifier |Age |

| | |Restriction |

|Q5106* |No |1mth&up |

* Procedure code is on review

VIII. HCPCS Procedure Codes Payable to Hospitals

The following 2019 HCPCS Procedure Codes are payable to Hospital Providers:

|Procedure Code |Modifier |Age |

| | |Restriction |

|C9031 |No |18y&up |

|C9035 |No |18y&up |

|C9036 |No |18y&up |

|C9037 |No |18y&up |

|C9038 |No |18y&up |

|C9039 |No |18y&up |

|C9407 |No |No |

|C9408 |No |No |

|C9462 |No |No |

|J0185 |No |18y&up |

|J0517 |No |12y&up |

|J0567 |No |3y&up |

|J0584 |No |1y&up |

|J0599 |No |12y&up |

|J1095 |No |No |

|J1628 |No |18y&up |

|J1746 |No |18y&up |

|J2062 |No |18y&up |

|J2186 |No |18y&up |

|J2797 |No |18y&up |

|J3245 |No |18y&up |

|J3304 |No |18y&up |

|J3316 |No |2y&up |

|J3397 |No |5m&up |

|J3398 |No |1y&up |

|J3591 |No |No |

|J7170 |No |No |

|J7177 |No |12y&up |

|J7203 |No |1y&up |

|J7318 |No |22y&up |

|J7329 |No |21y&up |

|J9044 |No |18y&up |

|J9057 |No |18y&up |

|J9153 |No |18y&up |

|J9173 |No |18y&up |

|J9229 |No |18y&up |

|J9311 |No |18y&up |

|J9312 |No |18y&up |

|Q2041 |No |18y&up |

|Q2042 |No |No |

|Q4186 |No |No |

|Q5103 |No |6y&up |

|Q5104 |No |6y&up |

|Q5105 |No |1mth&up |

|Q5106* |No |1mth&up |

|Q5108 |No |No |

|Q5110 |No |No |

* Procedure code is on review

IX. HCPCS Procedure Codes Payable to Nurse Practitioners

The following information is related to procedure codes payable to Nurse Practitioner Providers:

|Procedure Code |Modifier |Age |

| | |Restriction |

|C9035 |No |18y&up |

|C9037 |No |18y and up |

|C9039 |No |18y and up |

|C9462 |No |No |

|J0584 |No |1y&up |

|J1746 |No |18y&up |

|J2186 |No |18y&up |

|J2797 |No |18y&up |

|J3245 |No |18y&up |

|J3591 |No |No |

|J7170 |No |No |

|J7177 |No |12y&up |

|J7203 |No |1y&up |

|J9044 |No |18y&up |

|J9057 |No |18y&up |

|J9153 |No |18y&up |

|J9173 |No |18y&up |

|J9311 |No |18y&up |

|Q2042 |No |No |

|Q5103 |No |6y&up |

|Q5104 |No |6y&up |

|Q5106* |No |1mth&up |

|Q5108 |No |No |

|Q5110 |No |No |

* Procedure code is on review

X. HCPCS 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:

|Procedure Code |Modifier |Age |

| | |Restriction |

|C9031 |No |18&up |

|C9035 |No |18y&up |

|C9036 |No |18y&up |

|C9037 |No |18y&up |

|C9038 |No |18y&up |

|C9039 |No |18y&up |

|C9407 |No |No |

|C9408 |No |No |

|C9462 |No |No |

|J0185 |No |18y&up |

|J0517 |No |12y&up |

|J0567 |No |3y&up |

|J0584 |No |1y&up |

|J1095 |No |No |

|J1628 |No |18y&up |

|J1746 |No |18y&up |

|J2062 |No |18y&up |

|J2186 |No |18y&up |

|J2797 |No |18y&up |

|J3245 |No |18y&up |

|J3304 |No |18y&up |

|J3316 |No |2y&up |

|J3397 |No |5mth&up |

|J3398 |No |1y&up |

|J3591 |No |No |

|J7170 |No |No |

|J7177 |No |12y&up |

|J7203 |No |1y&up |

|J7318 |No |22y&up |

|J7329 |No |21&up |

|J9044 |No |18y&up |

|J9057 |No |18y&up |

|J9153 |No |18y&up |

|J9173 |No |18y&up |

|J9229 |No |18y&up |

|J9311 |No |18y&up |

|J9312 |No |18y&up |

|Q2042 |No |No |

|Q4186 |No |No |

|Q5103 |No |6y&up |

|Q5104 |No |6y&up |

|Q5105 |No |1mth&up |

|Q5106* |No |1mth&up |

|Q5108 |No |No |

|Q5110 |No |No |

* Procedure code is on review

XI. HCPCS Procedure Codes Payable to Podiatry

The following information is related to procedure codes payable to Podiatry Providers:

|Procedure Code |Modifier |Age |

| | |Restriction |

|Q4186 |No |No |

XII. HCPCS Procedure Codes Payable to Prosthetic

The following information is related to procedure codes payable to Prosthetic Providers:

|Procedure Code |Modifier |Modifier |Age |

| |1 |2 |Restriction |

|A5514 | | |21y&up |

|This procedure code requires a diagnosis of diabetes. |

|E0447 |NU | | |

|L8608 |EP | | |

|L8701 |EP | | |

|L8702 |EP | | |

XIII. HCPCS Procedure Codes Payable to Ventilator

The following information is related to procedure codes payable to Ventilator Providers:

|Procedure Code |

|E0467 |

XIV. Ambulatory Surgical Center (ASC)

The 2019 Medicare ASC Fee Schedule has been implemented into the Arkansas Medicaid ASC program retroactive to dates of service January 1, 2019. An updated fee schedule will be available soon.

XV. Non-Covered HCPCS Procedure Codes

The following 2019 HCPCS procedure codes are not covered by Arkansas Medicaid:

|A4563 |A6460 |A6461 |A9513 |A9589 |B4105 |

|C1823 |C8937 |C9749 |C9751 |C9752 |C9753 |

|C9754 |C9755 |G0068 |G0069 |G0070 |G0071 |

|G0076 |G0077 |G0078 |G0079 |G0080 |G0081 |

|G0082 |G0083 |G0084 |G0085 |G0086 |G0087 |

|G2000 |G2010 |G2011 |G2012 |G9873 |G9874 |

|G9875 |G9876 |G9877 |G9878 |G9879 |G9880 |

|G9881 |G9882 |G9883 |G9884 |G9885 |G9890 |

|G9891 |G9978 |G9979 |G9980 |G9981 |G9982 |

|G9983 |G9984 |G9985 |G9986 |G9987 |J0841 |

|J1301 |J1454 |J2787 |L8698 |M1000 |M1001 |

|M1002 |M1003 |M1004 |M1005 |M1006 |M1007 |

|M1008 |M1009 |M1010 |M1011 |M1012 |M1013 |

|M1014 |M1015 |M1016 |M1017 |M1018 |M1019 |

|M1020 |M1021 |M1022 |M1023 |M1024 |M1025 |

|M1026 |M1027 |M1028 |M1029 |M1030 |M1031 |

|M1032 |M1033 |M1034 |M1035 |M1036 |M1037 |

|M1038 |M1039 |M1040 |M1041 |M1042 |M1043 |

|M1044 |M1045 |M1046 |M1047 |M1048 |M1049 |

|M1050 |M1051 |M1052 |M1053 |M1054 |M1055 |

|M1056 |M1057 |M1058 |M1059 |M1060 |M1061 |

|M1062 |M1063 |M1064 |M1065 |M1066 |M1067 |

|M1068 |M1069 |M1070 |M1071 |Q4183 |Q4184 |

|Q4185 |Q4187 |Q4188 |Q4189 |Q4190 |Q4191 |

|Q4192 |Q4193 |Q4194 |Q4195 |Q4196 |Q4197 |

|Q4198 |Q4200 |Q4201 |Q4202 |Q4203 |Q4204 |

|Q5107 |Q5109 |Q5111 |T4545 | | |

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) 320-6429.

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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