016.06.06 Ark. Code R. 020
Place of Service | Paper Claims | Electronic Claims |
Outpatient Hospital | 2 | 22 |
Office | 3 | 11 |
Patient's Home | 4 | 12 |
Nursing Facility | 7 | 32 |
Skilled Nursing Facility | 8 | 31 |
Other Locations | 0 | 99 |
RSPMI Clinic (Telemedicine) | H | 99 |
Emergency Services in ER | X | 23 |
Type of Service | |
R- | RSPMI - (age 21 and older for services requiring PA) |
9- | RSPMI - (under age 21 and adults age 21 and older for services not requiring PA) |
V- | Telemedicine |
SUBJECT: Provider Manual Update Transmittal #61
Place of Service | Paper Claims | Electronic Claims |
Doctor's Office | 3 | 11 |
Patient's Home | 4 | 12 |
Nursing Facility | 7 | 32 |
Skilled Nursing Facility | 8 | 31 |
Other Locations | 0 | 99 |
The type of service code for chiropractic services is 9.
SUBJECT: Provider Manual Update Transmittal #82
Place of Service | Paper Claims | Electronic Claims |
Inpatient Hospital | 1 | 21 |
Outpatient Hospital | 2 | 22 |
Emergency Room | X | 23 |
Office/Clinic | 3 | 11 |
Nursing Facility | 7 | 32 |
Skilled Nursing Facility | 8 | 31 |
Other Location | 0 | 99 |
Ambulatory Surgical Center | B | 24 |
Inpatient Psychiatric Facility | G | 51 |
Type of Service Code | Description |
K | Dental |
1 | Medical |
2 | Surgical |
6 | EPSDT Screen |
7 | Anesthesia |
8 | Assistant at Surgery (requires prior authorization) |
C, PorT | Lab, X-Ray, Machine Test |
SUBJECT: Provider Manual Update Transmittal #60
The following procedure codes must be billed for ElderChoices Services:
Procedure Code | Modifiers | Description | Unit of Service | *POS for Paper Claims | *POS for Electronic Claims |
S5100 | " | Adult Day Care, 6 to 8 hours per date of service | 15 min | 5 | 99 |
S5100 | U1 | Adult Day Care, 4 or 5 hours per date of service | 15 min | 5 | 99 |
S5100 | TD | Adult Day Health Care, 6 to 8 hours per date of service | 15 min | 5 | 99 |
S5100 | TD, U1 | Adult Day Health Care, 4 or 5 hours per date of service | 15 min | 5 | 99 |
S5120 | - | Chore Services | 15 min | 4 | 12 |
S5130 | - | Homemaker Services | 15 min | 4 | 12 |
S5135 | - | Respite Care - Short-Term Facility-Based | 15 min | 5,1,7 | 99,21,32 |
S5140 | - | Adult Foster Care | 1 day | 0 | 99 |
S5150 | - | Respite Care - In-Home | 15 min | 4 | 12 |
S5160 | " | Personal Emergency Response System -Installation | One installation | 4 | 12 |
S5161 | UA | Personal Emergency Response System | 1 day | 4 | 12 |
S5170 | - | Frozen Home-Delivered Meal | 1 meal | 4 | 12 |
S5170 | U1 | Emergency Home Delivered Meals | 1 meal | 4 | 12 |
S5170 | U2 | Home-Delivered Meals | 1 meal | 4 | 12 |
T1005 | - | Respite Care - Long-Term Facility-Based | 15 min | 1 or 7 | 21,32,99 |
*Place of service code
Place of Service | Paper Claims | Electronic Claims |
Inpatient Hospital | 1 | 21 |
Patient's Home | 4 | 12 |
Day Care Facility | 5 | 99 |
Nursing Facility | 7 | 32 |
Other Locations | 0 | 99 |
The type of service code for ElderChoices services is 1.
SUBJECT: Provider Manual Update Transmittal #108
Place of Service | Paper Claims | Electronic Claims |
Inpatient Hospital | 1 | 21 |
Outpatient Hospital | 2 | 22 |
Doctor's Office | 3 | 11 |
Patient's Home | 4 | 12 |
Ambulatory Surgical Center | B | 24 |
Day Care Facility or DDTCS Facility | 5 | 99 |
Nursing Facility | 7 | 32 |
Skilled Nursing Facility | 8 | 31 |
Other Locations | 0 | 99 |
Independent Laboratory | A | 81 |
End Stage Renal Disease Treatment Facility | Ll_ | 65 |
Emergency Room | X | 23 |
Inpatient Psychiatric Facility | G | 51 |
Type of Service (TOS) | TOS Code |
Family Planning | A |
Telemedicine (evaluation and management services provided by physician at remote site) | V |
Telemedicine (professional component of radiology procedure performed by physician at remote site | W |
Telemedicine (technical component of X-ray or machine test transmitted from local to remote site | Y |
Telemedicine (evaluation/management services of attending physician at local site, in consultation with physician at emote site) | Z |
Medicine | 1 |
Surgery | 2 |
Anesthesia | 7 |
Assistant surgeon (requires prior authorization) | 8 |
Lab, machine test and X-ray TOS codes:
Description | TOS Code |
Professional component | P |
Technical component | T |
Complete procedure | C |
See Section 292.730 for definitions of P, T and C.
SUBJECT: Provider Manual Update Transmittal #55
Place of Service | Paper Claims | Electronic Claims |
Inpatient Hospital | 1 | 21 |
Outpatient Hospital | 2 | 22 |
Emergency Room - Hospital | X | 23 |
Patient's Home | 4 | 12 |
Nursing Facility | 7 | 32 |
Skilled Nursing Facility | 8 | 31 |
Ambulance | 9 | 41 |
Other Locations | 0 | 99 |
Ambulatory Surgical Center | B | 24 |
Federally Qualified Health Center (FQHC) | D | 50 |
Inpatient Psychiatric Facility | G | 51 |
Type of Service (TOS) | TOS Code |
FQHC Encounter | 9 |
Telemedicine | Y |
Surgery | 2 |
Family Planning | A |
SUBJECT: Provider Manual Update Transmittal #62
Place of Service | Paper Claims | Electronic Claims |
Inpatient Hospital | 1 | 21 |
Outpatient Hospital | 2 | 22 |
Office | 3 | 11 |
Patient's Home | 4 | 12 |
Day Care Facility | 5 | 99 |
Nursing Facility | 7 | 32 |
Skilled Nursing Facility | 8 | 31 |
Ambulance | 9 | 41 |
Other Locations | 0 | 99 |
Type of Service (TOS) | TOS Code |
Family Planning | A |
Nurse Practitioner | N |
EPSDT | 6 |
SUBJECT: Provider Manual Update Transmittal #63
SUBJECT: Provider Manual Update Transmittal #63
Place of Service | Paper Claims | Electronic Claims |
Inpatient Hospital | 1 | 21 |
Outpatient Hospital | 2 | 22 |
Emergency Room | X | 23 |
Doctor's Office | 3 | 11 |
Patient's Home | 4 | 12 |
Nursing Facility | 7 | 32 |
Skilled Nursing Facility | 8 | 31 |
Other Locations | 0 | 99 |
Ambulatory Surgical Center | B | 24 |
Inpatient Psychiatric Facility | G | 51 |
The type of service (TOS) code for podiatrist services is 4.
SUBJECT: Provider Manual Update Transmittal #52
Place of Service | Paper Claims | Electronic Claims |
Patient's Home | 4 | 12 |
Nursing Facility | 7 | 32 |
Skilled Nursing Facility | 8 | 31 |
The type of service code (TOS) for portable X-ray services is T.
016.06.06 Ark. Code R. 020