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Arkansas Total Care prior authorization updates effective June 1, 2024, for new American Medical Association Current Procedural Terminology (CPT®) codes

Date: 05/31/24

The following CPT Proprietary Laboratory Analyses (PLA) codes and CPT Category III codes are not new prior authorization requirements but are updated codes that will now require prior authorization, unless determined to be a non-covered service, upon their effective date of June 1, 2024. These are more specific codes that provide a detailed description of services that are not new, just more precisely defined. For existing codes, please use the Pre-Auth Check tool on our website to verify if prior authorization is needed.

CODE
DESCRIPTION
0020MONC CNS ALYS 30000
DNA METHYLATION LOCI TUM TISS
0450U
ONC MM LC-MS/MS
MONOCLONAL P-PRTN SEQ ALYS SERUM
0451U
ONC MM LC-MS/MS
PEPTIDE ION QUANTIFICATION SERUM
0452U
ONC BLADDER MTHYL PENK DNA DETCJ LTE-QMSP URINE
0453U
ONC CLRCT CA CFDNA MTHYLTN BSD QUAN PCR ASY PLSM
0454URARE DS ID VRTJ INVRJ INSJ TLCJ OPT GENOME MAPG


0456U


AI RA NGS GEN XPRSN 19 GEN WHL BLD ALYS ANTI-CCP
0457UPFAS 9 PFAS COMPOUNDS LC-MS/MS PLASMA/SERUM QUAN
0458UONC BREAST CA S100 A8&A9 ELISA TEAR FLUID ALG
0459U
ABETA42 & TTAU ECLIA CEREBRAL SPINAL FLUID RATIO
0460U
ONC WHL BLD/BUCCAL DNA SNP GNOTYP RT-PCR 24 GENE
0461UONC RX-GENOMIC ALYS SNP GNOTYP RT-PCR 24 GENES
0462UMELATONIN LVL TEST SLEEP STUDY 7/9 SAMPLE ELISA
0463UONC CERVIX MRNA GENXPRSN 14 BMRK E6&E7 HPV NASBA
0465UONC UROTHELIAL CARC DNA QMSP 2 GENES ALG ALYS
0466UCRD CAD DNA GWAS 564856 SNP TRGT VARIANT GNOTYP
0467UONC BLDR DNA NGS 60 GEN&WHL GENOME ANEUP UR ALG
0468UHEP NASH MIR-34A-5P A2M YKL40 HBA1C SRM&WHL BLD
0469URARE DS WHL GENOM SEQ ALYS CHRMOML ABNR FTL SAMP
0470U
ONC OROP DETCJ MRD NGS QUAN EVAL 8DNA CFHPV16&18
0472UCA VI PSP&SP1 ANTB ELISA SEMIQL BLD SJOGREN SYND
0473UONC SOLID TUMOR NGS DNA FFPE TISS BLD/SLV 648GEN
0474UHERED PAN CA GSAP 88 GENES 20DUP/DEL NGS BLD/SLV
0475UHERED PRST8 CA-RLTD DO GSAP NGS CGH EVAL 23 GENE
0867TTPLA B9 PROSTATIC HYPERPLASIA PRST8 VOL>=50 ML
0868THIGH-RESOLUTION GASTRIC ELECTROPHYSIOLOGY MAPG
0869TNJX B1 SUB MATRL B1&/SFT TISSUE HW FIXJ AGMNTJ
0870TIMPLANTATION SUBQ PERITONEAL ASCITES PUMP SYS
0871TREPLACEMENT SUBCUTANEOUS PERITONEAL ASCITES PUMP
0872TRPLCMT INDWELLING BLADDER & PERITONEAL CATHETERS
0873TREVJ SUBQ IMPL PERITONEAL ASCITES PUMP SYSTEM
0874TREMOVAL PERITONEAL ASCITES PUMP SYSTEM
0876TDUPLEX SCAN HEMODIALYSIS FISTULA CPTR AIDED LMTD
0877TAUGMNT ALYS CH CT IMG DATA ILD WO CNCRNT CT EXAM
0878TAUGMNT ALYS CH CT IMG DATA ILD W/CNCRNT CT EXAM
0879TAUGMNT ALYS CH CT IMG DATA ILD DATA PREP&TRNSMS
0880TAUGMNT ALYS CH CT IMG DATA ILD PHYS/QHP I&R
0881TCRTX ORAL CAVITY TEMP REGULATED FLU COOLING SYS
0884TESPHGSC FLX TRNSORL 1ST TNDSC DILAT RX BALO CATH
0885TCOLSC FLX TRNSORL 1ST TNDSC DILAT RX BALO CATH
0886TSGMDSC FLX TRNSORL 1ST TNDSC DILAT RX BALO CATH
0888THISTOTRIPSY MALIGNANT RENAL TISSUE W/IMG GDN
0889TPERSONALIZED TARGET DEVELOPMENT ARHFCMRIGTBS
0890TARHFCMRIGTBS 1ST MOTOR THRESHOLD DETER 1ST TX D
0891TARHFCMRIGTBS SUBSEQUENT TREATMENT DAY
0892TARHFCMRIGTBS SBSQ MOTOR THRESHLD REDETER PR TX D
0893TN-INVAS ASSMT BLD OXY GAS XCHNG EFF&CARDRESP I&R
0897TN-INVAS AUGMNT ARRHYT ALYS QUAN CAR ARRHYT SIMUL
0898TNONINVASIVE PROSTATE CANCER ESTIMATION MAP
0899TN-INVAS DETER AQMBF AUGMNT ALG ALYS DATASET CMR