A. Both diagnostic laboratory and radiology/other services in all settings, including ASCs, are subject to a benefit limit.
1. Diagnostic laboratory services benefits are limited to five hundred dollars ($500) per State Fiscal Year (SFY: July 1 through June 30), and radiology/other services benefits are limited to five hundred dollars ($500) per SFY.
2. Radiology/other services include without limitation diagnostic X-rays, ultrasounds, and electronic monitoring/machine tests, such as electrocardiograms (ECG or EKG).
3. Diagnostic laboratory services and radiology/other services defined as Essential Health Benefits by the U.S. Preventive Services Task Force (USPSTF) are exempt from counting toward either of the two new annual caps.
View or print the essential health benefit procedure codes.
B. Magnetic resonance imaging (MRI) services are exempt from the radiology/other services benefit limit per SFY.
C. Individuals under twenty-one (21) years of age are not subject to the diagnostic laboratory services benefit limit or to the radiology/other services benefit limit, except for the limitations on fetal echography (ultrasound) and fetal non-stress tests.
Credits
Eff. Nov. 1, 2007; Oct. 13, 2003; Feb. 1, 2005; May 1, 2008; June 15, 2006. Amended July 15, 2012; July 1, 2014; July 1, 2022.
<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 016.06.3-215.110, AR ADC 016.06.3-215.110
