016.06.06 Ark. Code R. 027 - Prosthetics Update #81 and Certified Nurse Midwife Update #74

Section II Prosthetics

242.200 Place of Service, Type of Service and Modifier Codes

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
Day Care Facility	5	52
Night Care Facility	6	52
Nursing Facility	7	32
Skilled Nursing Facility	8	31
Ambulance	9	41
Other Locations	0	99
Independent Laboratory	A	81
Ambulatory Surgical Center	B	24
Residential Treatment Center	C	56
Specialized Treatment Facility	D	56
Comprehensive Outpatient Rehabilitative Facility	E	62
Independent Kidney Disease Treatment Center	F	65
Inpatient Psychiatric Facility	G	51

Type of Service (paper only)

H-Over 21

U-Used Equipment

I-Initial Rental

6-Under 21

Modifiers

EP- Service provided as part of EPSDT Program

KH-Durable Medical Equipment (DME) item, initial claim, first month's rental

NU-New Equipment

RR-Durable Medical Equipment (DME) Rental

U1-Medicaid Level of Care 1 (defined by state)

U2-Medicaid level of Care 2 (defined by state)

U3-Medicaid level of care 3 (defined by state)

Modifiers

U4-Medicaid level of care 4 (defined by state)

U5-Medicaid level of care 5 (defined by state)

UE-Used durable medical equipment (DME)

52-Reduced Services

Section II

Certified Nurse-Midwife

272.200 Place of Service and Type of Service Codes

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
Nursing Facility	7	32
Skilled Nursing Facility	8	31
Other Locations	0	99
Independent Laboratory	A	81
Ambulatory Surgical Center	B	24
Specialized Treatment Facility or Federally Qualified Health Center (FQHC)	D	56
Emergency Department for Emergency Services	X	23

Type of Service (paper only)

9 - Certified Nurse- Midwife

A - Family Planning

Notes

016.06.06 Ark. Code R. 027

6/1/2006