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016.06.3-242.410. Billing of Multi-Use and Single-Use Vials

AR ADC 016.06.3-242.410Arkansas Administrative CodeEffective: January 1, 2023

West's Arkansas Administrative Code
Title 016. Department of Human Services
Division 06. Division of Medical Services
Rule 3. Ambulatory Surgical Center Provider Manual (Refs & Annos)
Section 240.000. Billing Procedures
Effective: January 1, 2023
Ark. Admin. Code 016.06.3-242.410
016.06.3-242.410. Billing of Multi-Use and Single-Use Vials
Currentness
Arkansas Medicaid follows the billing protocol per the Federal Deficit Reduction Act of 2005 for drugs.
A. Multiple units may be billed when applicable. Take-home drugs are not covered. Drugs loaded into an infusion pump are not classified as “take-home drugs.” Refer to payable CPT code ranges 96365 through 96379.
B. When submitting Arkansas Medicaid drug claims, drug units should be reported in multiples of the dosage included in the HCPCS procedure code description. If the dosage given is not a multiple of the number provided in the HCPCS code description, the provider shall round up to the nearest whole number in order to express the HCPCS description number as a multiple.
1. Single-Use Vials: If the provider must discard the remainder of a single-use vial or other package after administering the prescribed dosage of any given drug, Arkansas Medicaid will cover the amount of the drug discarded along with the amount administered. Discarded drugs shall be billed on a separate detail line with a JW (Drug wastage) modifier.
2. Multi-Use Vials: Multi-use vials are not subject to payment for any discarded amounts of the drug. The units billed must correspond with the units administered to the beneficiary.
3. Documentation: The provider must clearly document in the patient's medical record the actual dose administered in addition to the exact amount wasted and the total amount the vial is labeled to contain.
Remember to verify the milligrams given to the patient and then convert to the proper units for billing.
Follow the Centers for Disease Control (CDC) requirements for safe practices regarding expiration and sterility of multi-use vials.

Credits

Eff. Nov. 1, 2008; Nov. 1, 2007; May 1, 2007; July 1, 2007. Amended March 7, 2014; July 1, 2014; Nov. 29, 2015; Jan. 1, 2023.
<Editor’s Note: Nonfunctioning links so in original.>
Current with amendments received through February 15, 2024. Some sections may be more current, see credit for details.
Ark. Admin. Code 016.06.3-242.410, AR ADC 016.06.3-242.410
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