Arkansas Department
/Of Health and Human Services
Division of Medical ServicesP.O. Box 1437, Slot S295
Little Rock, AR 72203-1437
Fax: 501-682-2480 / TDD & Voice: 501-682-6789 / InternetWebsite: medicaid.mmis.arkansas.gov
OFFICIAL NOTICE
DMS-2006-A-1 / DMS-2006-G-1 / DMS-2006-L-1 / DMS-2006-R-1 / DMS-2006-YC-1DMS-2006-AR-1 / DMS-2006-CA-1 / DMS-2006-SS-1 / DMS-2006-EE-1 / DMS-2006-OO-1
DMS-2006-O-1 / DMS-2006-Z-1 / DMS-2006-DD-1 / DMS-2006-QQ-1 / DMS-2006-SB-1
DMS-2006-HH-1 / DMS-2006-II-1 / DMS-2006-KK-1 / DMS-2006-YY-1 / DMS-2006-U-1
DMS-2006-C-1
TO:Health Care Provider –Ambulatory Surgical Center; ARKids First-B; Certified Nurse-Midwife; Certified Registered Nurse Anesthetists (CRNA); Child Health Management Services (CHMS); Child Health Services (EPSDT); Critical Access Hospital; End State Renal Disease; Federally Qualified Health Center (FQHC); Hospital; Independent Labs; Licensed Mental Health Practitioner (LMHP); Nurse Practitioner; Physician; Podiatrist; Radiation Therapy Center; Rehabilitative Services for Persons with Mental Illness (RSPMI); Rehabilitative Services for Youth and Children (RSYC); Rural Health Clinic (RHC); School-Based Mental Health Services; Visual and Arkansas Division of Health
DATE:March 15, 2006
SUBJECT:2006 CPT Procedure Code Conversion
I.General Information
A review of the 2006 CPT procedure codes has been completed, and the Arkansas Medicaid Program will begin accepting CPT 2006 procedure codes for dates of service on and after March 1, 2006. Please add this information to your Medicaid provider manual until revised manual sections have been included in future updates.
Procedure codes that are identified in the CPT 2006 (Appendix B) are non-payable for dates of service on and after March 1, 2006.
II.Non-Covered 2006 CPT Procedure Codes
A.The following 2006 CPT procedure codes are non-covered for all providers.
43770 / 43771 / 43772 / 43773 / 4377443886 / 43887 / 43888 / 83037 / 90649
90736 / 90760 / 90761 / 90773 / 95251
96102 / 96103 / 96116 / 96119 / 96120
97760 / 97761 / 98960 / 98961 / 98962
99324 / 99325 / 99326 / 99327 / 99328
99334 / 99335 / 99336 / 99337 / 99339
99340
B.The following 2006 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.
15111 / 15116 / 15131 / 15136 / 1515115152 / 15156 / 15157 / 15171 / 15176
15301 / 15321 / 15331 / 15336 / 15341
15361 / 15366 / 15421 / 15431 / 22525
33768 / 33884 / 37185 / 37186 / 44213
58110 / 61641 / 61642 / 75956 / 75957
75958 / 75959 / 90766 / 90767 / 90768
90774 / 90775
C.Effective for dates of service on and after March 1, 2006, the following currently payable CPT procedure codes will become non-payable because the services are covered by another CPT procedure code or another HCPCS code for physicians, osteopaths and AHECS.
99050 / 99056 / 99058Effective for dates of service on and after March 1, 2006, the following 2006 CPT procedure codes will be non-payable because the services are covered by another CPT procedure code or HCPCS code for physicians, osteopaths and AHECS.
90772 / 99051 / 99053 / 99060D.All 2006 CPT procedure codes listed in Category II and Category III are non-covered.
III.Prior Authorization
The following 2006 CPT procedure codes require prior authorization (PA).
01966For procedure code 01966, the source for prior authorization is determined by the
same criteria as deleted code 01964.
IV.Diagnosis Codes
Effective for dates of service on and after March 1, 2006, diagnosis codes in range 230.0 through 238.9are also recognized as cancer diagnosis codes.
V.Special Billing Requirements
A.The following 2006 CPT procedure codes require paper claims and supporting documentation.
01965 / Procedure requires ICD-9-CM diagnosis code 631, 632, or 634.00 through 634.9201966 / Procedure requires prior authorization. For Medicaid, provider manual protocol and billing requirements must be followed the same as the deleted procedure code 01964.
44180 45499 45990 51999 / Claim requires operative report.
76376 76377 / Claim requires medical history and physical
28890 / History and physical showing treatment failure of previous conservative therapy, (i.e. NSAIDS, cortisone shots, and physical therapy)
B.The following 2006 CPT procedure codes require documentation to justify the procedure billed, except when the claim is for diagnosis codes 940.0 through 949.5.
15170 / 15171 / 15175 / 15176VI.Podiatry Program
The following procedure codes are payable to podiatry providers.
15115 / 15116 / 15135 / 15136 / 1515515156 / 15157 / 15170* / 15171* / 15175*
15176* / 15320 / 15321 / 15335 / 15336
15340 / 15341 / 15365 / 15366 / 15420
15421 / 28890 / 99304 / 99305 / 99306
99307 / 99308 / 99309 / 99310 / 99318
* These procedure codes require documentation to justify the procedure billed, except when the claim is for diagnosis codes 940.0 through 949.5.
VII.Certified Nurse-Midwife
A.The following 2006 CPT procedure codes are payable to certified nurse-midwifeproviders.
90765 / 90766 / 90767 / 90768 / 9077490775 / 90779
B.Effective for dates of service on and after March 1, 2006, CPT procedure code 90799 is replaced by existing HCPCS procedure code T1502. HCPCS procedure code T1502 is to be used for “administration only”of IM and/or subcutaneous injections and requires a modifier U1 when billed electronically or on paper. Use type of service “9” when filing paper claims. Procedure codeT1502must be billed when the drug is not supplied by the provider who administers the drug.
VIII.Nurse Practitioner
A.The following 2006 CPT procedure codes are payable to nurse practitioner providers.
90714 / 90765 / 90766 / 90767 / 9076890774 / 90775 / 90779 / 96401 / 96402
96409 / 96411 / 96413 / 96415 / 96416
96417 / 96521 / 96522 / 96523 / 97760
97761 / 97762 / 99304 / 99305 / 99306
99307 / 99308 / 99309 / 99310 / 99318
B.Effective for dates of service on and after March 1, 2006, CPT procedure code 90799 is replaced by existing HCPCS procedure code T1502. HCPCS procedure code T1502 is to be used for “administration only”of IM and/or subcutaneous injections. Procedure code T1502 may be billed electronically or on paper. Use type of service “N” when filing paper claims. Procedure code T1502 must be billed when the drug is not supplied by the provider who administers the drug.
IX.Oral Surgeon
A.The following CPT procedure codes are payable to oral surgeons effective for dates of service on and after March 1, 2006.
15040 / 15115 / 15116 / 15135 / 1513615155 / 15156 / 15157 / 15175* / 15176*
15320 / 15321 / 15335 / 15336 / 15365
15366 / 15420 / 15421 / 90765 / 90766
90767 / 90768 / 90774 / 90775 / 90779
99143 / 99144 / 99145 / 99148 / 99149
99150
* These procedure codes require documentation to justify the procedure billed, except when the claim is for diagnosis codes 940.0 through 949.5.
B.Effective for dates of service on and after March 1, 2006, CPT procedure code 90799 is replaced by existing HCPCS procedure code T1502. HCPCS procedure code T1502 is to be used for “administration only”of IM and/or subcutaneous injections. Procedure code T1502 may be billed electronically or on paper. Use type of service “1” when filing paper claims. Procedure code T1502 must be billed when the drug is not supplied by the provider who administers the drug.
X.OutpatientHospital
Use procedure code 90765 for IV infusion therapy. For additional hours, sequential and/or concurrent infusions, bill revenue code 0760 (for observation), up to 8 hours maximum per day.
XI.Physician
Effective for dates of service on and after March 1, 2006, CPT procedure code 90799 is replaced by existing HCPCS procedure code T1502. HCPCS procedure code T1502 is to be used for “administration only”of IM and/or subcutaneous injections. Procedure code T1502 may be billed electronically or on paper. Use type of service “1” when filing paper claims. Procedure code T1502 must be billed when the drug is not supplied by the provider who administers the drug.
XII.Child Health Services (EPSDT
Effective for dates of service on and after March 1, 2006, CPT procedure code 90799 is replaced by existing HCPCS procedure code T1502. HCPCS procedure code T1502 is to be used for “administration only”of IM and/or subcutaneous injections. Procedure code T1502 may be billed electronically or on paper. Use type of service “6” when filing paper claims. Procedure code T1502 must be billed when the drug is not supplied by the provider who administers the drug.
XIII.Child Health Management Services (CHMS)
A.Effective for dates of service on and after March 1, 2006, the following 2006 CPT procedure codes are payable to CHMS programs.
96101 / 96118 / 97762B.Procedure code 96100 has been deleted from the 2006 CPT book and is replaced by 96101. The following modifiers must be used with 96101 when filing claims for the CHMS services
Modifier(s) / DescriptionUA, UB / Psychological Testing Battery
U1, UA / Psychological Testing – children entering foster care
UA / Interpretation – children entering foster care
C.CHMS procedure code 96117 has been deleted from 2006 CPT. This procedure code has been replaced with procedure code 96118.
D.CHMS procedure code 97703 has been deleted from 2006 CPT. It is replaced with 97762. Procedure code97762 will require PA as all other CHMS treatment procedures.
XIV.Rehabilitative Services for Persons with Mental Illness
A.Effective for dates of service on and after March 1, 2006, procedure code 96100 has been deleted and is non-payable. It has been replaced with 2006 CPT procedure code 96101.
B.The modifiers listed below must be used with procedure code 96101 when filing claims for the RSPMI services described.
Modifier(s) / DescriptionHA, UA / Diagnosis – Psychological Test/Evaluation
HA, UA, UB / Diagnosis – Psychological Testing Battery
XV.School-Based Mental Health (SBMH)
Effective for dates of service on and March 1, 2006, procedure code 96100 has been deleted and is non-payable. It is replaced by procedure code 96101. The modifiers listed below must be used with procedure code 96101 when filing claims for the SBMH services described.
Modifier(s) / DescriptionUA / Diagnosis – Psychological Test/Evaluation
UA, UB / Diagnosis – Psychological Testing Battery
XVI.Licensed Mental Health Practitioner (LMHP)
Effective for dates of service on and after March 1, 2006, procedure code 96100 has been deleted and is non-payable. It is replaced by procedure code 96101. The modifiers listed below must be used with procedure code 96101 when filing claims for the LMHP services described. This procedure is only payable to psychologists.
Modifier(s) / DescriptionUA / Diagnosis – Psychological Test/Evaluation
UA, UB / Diagnosis – Psychological Testing Battery
XVII.Rehabilitative Services for Youth and Children (RSYC)
Effective for dates of service on and after March 1, 2006, procedure code 96100 has been deleted and is non-payable. It is replaced by procedure code 96101. The modifiers listed below must be used with procedure code 96101 when filing claims for the RSYC services described.
Modifier(s) / DescriptionUA, UB / Psychological Testing Battery
XVIII.Additional Information
Complete descriptions of CPT 2006 procedure codes are in the CPT 2006 book. This book may be purchased from Ingenix online at or by calling 1-800-464-3649.
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) 6826789.
If you have questions regarding this notice, please contact the EDS ProviderAssistanceCenter 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: medicaid.mmis.arkansas.gov.
Roy Jeffus, Director