016.06.06 Ark. Code R. 045
Dental services for ARKids First-B participants are limited to one (1) initial oral exam, bite-wings, scalings and prophylaxis/fluoride treatments per state fiscal year (July 1-June 30). The procedure codes listed in the table below may be billed for the prophylaxis/fluoride.
Procedure Code | Description |
D1110 | Prophylaxis - adult (ages 10-20) |
D1120 | Prophylaxis - child (ages 0-9) |
D1201 | Topical application of fluoride (including prophylaxis) - child (ages 0-9) |
D1205 | Topical application of fluoride (including prophylaxis) - adult (ages 10-18) |
Refer to Section II of the Dental Provider Manual for a complete listing of covered dental services. Orthodontia Services are not covered for ARKids First-B participants.
Procedure codes for treatment services that are not shown as payable may be requested on treatment plans subject to review and approval by the Division of Medical Services dental consultants if such treatment is deemed medically necessary.
Procedure code D0120 must be billed for an initial/periodic preventive dental screening. ARKids First-B participants are limited to one (1) dental screen (initial oral exam) per state fiscal year (July 1-June 30).
ARKids First-B participants may receive interperiodic preventive dental screening. There is no limit on this service. However, prior authorization must be obtained in order to receive reimbursement. See Section 240.200 for prior authorization information.
Procedure code D0140 must be billed for an interperiodic preventive dental screen. This service requires prior authorization.
One routine eye exam (refraction) every twelve months is covered for ARKids First-B participants.
Refer to Section II of the Visual Care Provider Manual for a complete listing of covered visual services.
There are two (2) preventive health screening procedure codes to be used when billing for this service for ARKids First-B participants.
The initial ARKids First-B preventive health screen for newborns is similar to Routine Newborn Care in the Arkansas Medicaid Physician and Child Health Services (EPSDT) Programs.
For routine newborn care following a vaginal delivery of C-section, procedure codes 99431, 99432 or 99435 should be used one time to cover all newborn care visits by the attending physician. Payment of these codes is considered a global rate and subsequent visits may not be billed in addition to 99431, 99432 and 99435. These codes include the physical exam of the baby and the conference(s) with the newborn's parent(s), and are considered to be the initial Health screening.
For illness care, e.g., neonatal jaundice, use procedure codes 99221 through 99223. Do not bill 99431, 99432 or 99435 in addition to these codes.
Bill the program for ARKids First-B Preventive Health Screening 99381-99385 or 99391-99395 for all subsequent preventive health screenings after the date of birth.
A preventive health screening in the ARKids First-B Program is similar to an EPSDT screen in the Arkansas Medicaid Child Health Services (EPSDT) Program.
Providers may not bill ARKids First-B for CPT evaluation and management procedure codes in addition to procedure code 99381-99385 or 99391-99395.
ARKids First-B reimburses providers for preventive health screenings performed at the intervals recommended by the American Academy of Pediatrics.
References in this section indicate that ARKids First-B preventive health screenings are similar to Arkansas Medicaid Child Health Services (EPSDT) screens. However, please note these important distinctions:
NOTE: Certified nurse-midwives are restricted to performing the preventive health screen, Newborn 99431, 99432 or 99435 . They may not bill procedure code 99381-99385 or 99391-99395.
The Vaccines for Children (VFC) Program was established to generate awareness and access for childhood immunizations. These vaccines are available for ARKids First-B participants who are under the age of 19. To enroll in the VFC Program, contact the Division of Health. Providers may also obtain the vaccines to administer from the Division of Health. View or print the Division of Health contact information.
Vaccines available through the VFC program are covered for ARKids First-B participants. The administration fee only is reimbursed. When filing claims for administering VFC vaccines, providers must use the CPT procedure code for the vaccine administered. Electronic and paper claims require the modifier TJ. When filing paper claims, use type of service code 1 and modifier TJ on the claim form.
For information about vaccines covered through the VFC program, contact the Division of Health (see contact link above).
016.06.06 Ark. Code R. 045