What types of policy changes does Arkansas Medicaid issue?

Arkansas Medicaid regularly publishes coverage updates including prior authorization requirement changes, billing code additions or deletions, plan-type coverage modifications, and clinical policy revisions. PolicyChanges.app monitors these notices and summarizes the impact for providers.

How often does Arkansas Medicaid update its policies?

Arkansas Medicaid typically releases policy bulletins on a rolling basis throughout the year. Our system checks for new updates daily and adds them to this feed as soon as they are identified.

How many Arkansas Medicaid policy changes are tracked here?

This page currently tracks 38 documented Arkansas Medicaid policy changes. New items are added as they are identified.

What should I do when Arkansas Medicaid changes a prior authorization policy?

Review each change's effective date and action-required notes. Update your billing and clinical workflows before the effective date to avoid claim denials. Each policy detail page on PolicyChanges.app includes a plain-English summary and action items.

Arkansas Medicaid Policy Changes & Prior Auth Updates

We track 38 documented policy changes from Arkansas Medicaid across AR. Each entry includes an AI-generated plain-English summary, effective date, affected billing codes, and a direct link to the original Arkansas Medicaid notice. Use the related links below to narrow results by specialty or state, or sign up for a free daily alert to receive new Arkansas Medicaid updates automatically.

High impact
Whole Exome Sequencing (WES) Clinical Criteria (CPT 81415, 81416, 81417)
Arkansas Medicaid·Effective May 22, 2026
Arkansas has issued new clinical criteria for Whole Exome Sequencing (WES) billing under CPT codes 81415, 81416, and 81417. This is a fresh policy update (1 day old) that establishes procedural coding requirements and likely clinical necessity thresholds for WES testing. The billing team must obtain and review the full policy document to understand specific clinical criteria, prior authorization requirements, and documentation needs.
High impact
2026 ICD10-PCS Revisions Effective 4/1/2026
Arkansas Medicaid·Effective Apr 1, 2026
This policy announces the 2026 ICD-10-PCS procedure code revisions that take effect April 1, 2026. The billing team must obtain and implement updated procedure codes in their billing system to ensure accurate coding and claim processing starting on the effective date.
High impact
Coverage for Casgevy (J3392) and Lyfgenia (J3394) for the Sickle Cell Gene Therapy Model
Arkansas Medicaid·Effective Mar 24, 2026
Arkansas has issued a new pharmacy coverage policy for Casgevy (J3392) and Lyfgenia (J3394), two gene therapy medications for sickle cell disease. This policy establishes coverage parameters and billing requirements for these specialty drugs under the Sickle Cell Gene Therapy Model, effective immediately.
High impact
2026 Annual and Quarter 1 Healthcare Common Procedure Coding System Level II (HCPCS) Code, Current Procedural Terminology (CPT), and ASC Code Conversion
Arkansas Medicaid·Effective Jan 1, 2026
This is the 2026 annual and Q1 Healthcare coding system update for Arkansas that addresses changes to HCPCS Level II, CPT, and ASC codes. The policy document is a summary-only reference without specific code details accessible in the provided source material.
High impact
2026 ICD10-CM/PCS Revisions Effective 10/1/2025
Arkansas Medicaid·Effective Oct 1, 2025
The Arkansas Department of Human Services has released the 2026 ICD-10-CM/PCS code revisions effective October 1, 2025. This annual update includes new, revised, and deleted procedure codes that must be implemented in billing systems and provider documentation to ensure accurate coding and claim processing.
High impact
Coverage for Procedure Codes 58300 and 58301
Arkansas Medicaid·Identified Jul 17, 2025
Arkansas has issued a provider notice regarding coverage for procedure codes 58300 and 58301. However, the policy document content is not provided in this summary—only metadata is available. The billing team cannot determine specific coverage changes, requirements, or effective dates without access to the full policy document.
High impact
REVISED New Coverage - Presumptive Eligibility – Pregnant Women (PE-PW)
Arkansas Medicaid·Identified Jul 2, 2025
Unable to provide complete analysis. The policy document (ON-020-25.docx) was not accessible for review—only the summary metadata was available. This appears to be a revised billing instruction for Presumptive Eligibility coverage for pregnant women under Arkansas Medicaid, posted July 2, 2025. Full policy details, effective dates, specific billing codes, and implementation requirements cannot be confirmed without access to the complete document.
Medium impact
Prior Authorization required on Procedure Codes A4224 and A4225
Arkansas Medicaid·Effective Jun 19, 2026
Arkansas Medicaid now requires prior authorization for HCPCS procedure codes A4224 and A4225, effective immediately. Billing teams must obtain approval before submitting claims for these codes or face claim denials.
Medium impact
Coverage Added for J0174 and J0175
Arkansas Medicaid·Effective Jun 5, 2026
Arkansas has added coverage for HCPCS codes J0174 and J0175 (pharmacy procedure codes). The billing team must verify these codes are now covered and billable for Arkansas Medicaid claims effective immediately.
Medium impact
Whole Genome Sequencing (WGS) Clinical Criteria (CPT 81425, 81426, 814271)
Arkansas Medicaid·Effective May 22, 2026
Arkansas has updated clinical criteria for Whole Genome Sequencing (WGS) billing codes CPT 81425, 81426, and 81427. This is a brand new policy effective immediately that establishes specific medical necessity requirements for these genetic testing procedures. Billing teams must review the detailed clinical criteria document to understand what documentation and patient scenarios qualify for coverage before submitting claims.
Medium impact
Act 515 - Allow Providers Additional Time to Respond to Adverse Decisions
Arkansas Medicaid·Effective Mar 24, 2026
Act 515 extends the timeframe that healthcare providers have to respond to adverse coverage decisions from payers. This change applies to appeal response deadlines, giving providers additional time to submit appeals or reconsideration requests before claims are finalized as denials.
Medium impact
Other Medical Service PA Process Type Now Available for Carved-Out Drugs and Services
Arkansas Medicaid·Effective Mar 2, 2026
Arkansas is now offering an alternative prior authorization process type for carved-out drugs and services under the 'Other Medical Service' PA category. This expands PA submission options and may simplify authorization workflows for certain services. Billing teams need to understand when to use this new process versus existing PA methods.
Medium impact
Eating Disorder Services – No PCP Referral Required
Arkansas Medicaid·Effective Jan 7, 2026
Arkansas has eliminated the requirement for patients to obtain a Primary Care Physician (PCP) referral before accessing eating disorder services. This streamlines access to specialized eating disorder treatment by allowing direct referrals and self-referrals. Billing teams must update authorization workflows to reflect that PCP referrals are no longer a prerequisite for these services.
Medium impact
Coverage for Home Sleep Study (Proc Codes 95800, 95801, and 95806)
Arkansas Medicaid·Effective Dec 3, 2025
Arkansas has issued a provider notice regarding coverage for Home Sleep Study procedures (CPT 95800, 95801, 95806). The policy was posted on December 3, 2025, and appears to establish or clarify coverage parameters for these sleep study codes. However, the actual policy content is not available in this summary—only the title and source URL are provided.
Medium impact
New Coverage for B4100 U1 – SIMPLY THICK FOOD THICKENER ORAL - CONCENTRATE/1 OZ
Arkansas Medicaid·Effective Nov 3, 2025
Arkansas Medicaid has added new coverage for B4100 U1 (SIMPLY THICK FOOD THICKENER ORAL - CONCENTRATE/1 OZ), a food thickening product. Billing teams must recognize this HCPCS code as a covered procedure code effective immediately and ensure claims are processed under the correct category.
Medium impact
Federal Revalidation Guidance from CMS
Arkansas Medicaid·Identified Jun 19, 2026
Failed to analyze policy change
Medium impact
Updates to Skin Substitute Procedures
Arkansas Medicaid·Identified Jun 4, 2026
Failed to analyze policy change
Medium impact
REVISED: Continuous Glucose Monitor (CGM) Systems and Supplies – Effective 6/1/2026
Arkansas Medicaid·Identified Jun 3, 2026
Failed to analyze policy change
Medium impact
Physical Therapist Coverage for Nerve Conduction Study (NCS)
Arkansas Medicaid·Identified May 7, 2026
This policy addresses Physical Therapist coverage for Nerve Conduction Study (NCS) procedures in Arkansas. However, the provided information is a summary only and lacks specific coverage details, billing codes, effective dates, and implementation requirements needed for billing team action.
Medium impact
2026 Quarter 2 Healthcare Common Procedure Coding System Level II (HCPCS) Code and Current Procedural Terminology (CPT) Code Conversion
Arkansas Medicaid·Identified Apr 30, 2026
Failed to analyze policy change
Medium impact
FQHC and RHC Billing Guidelines for Postpartum
Arkansas Medicaid·Identified Apr 24, 2026
Failed to analyze policy change
Medium impact
REVISED: 2025 Quarter 2 Healthcare Common Procedure Coding System Level II (HCPCS) Code and Current Procedural Terminology (CPT) Code Conversion
Arkansas Medicaid·Identified Feb 11, 2026
Failed to analyze policy change
Medium impact
Drugs and Services Carved Out of Physician Administered Drug Prior Authorizations Submitted to Prime Therapeutics
Arkansas Medicaid·Identified Feb 2, 2026
Failed to analyze policy change
Medium impact
Coverage for Procedure Code D9245
Arkansas Medicaid·Identified Jan 16, 2026
Failed to analyze policy change
Medium impact
Extension of Prior Authorization (PA) for Hyperalimentation Services if the Beneficiary has a Chronic Condition
Arkansas Medicaid·Identified Jan 6, 2026
Failed to analyze policy change
Medium impact
Upcoming Changes to Prior Authorization Process for Physician-Administered Drugs – Effective January 1, 2026
Arkansas Medicaid·Identified Dec 19, 2025
Failed to analyze policy change
Medium impact
REVISED: 2025 Quarter 4 Healthcare Common Procedure Coding System Level II (HCPCS) Code and Current Procedural Terminology (CPT) Code Conversion
Arkansas Medicaid·Identified Nov 14, 2025
Failed to analyze policy change
Medium impact
Change to Prior Authorization Process for Physician-Administered Drugs – Effective January 1, 2026
Arkansas Medicaid·Identified Nov 3, 2025
Failed to analyze policy change
Medium impact
Technical Denial Indicator for Prior Authorizations
Arkansas Medicaid·Identified Oct 23, 2025
Failed to analyze policy change
Medium impact
2026 NUBC/UB04 Changes
Arkansas Medicaid·Identified Oct 15, 2025
Failed to analyze policy change
Medium impact
Coverage for Procedure Codes 61736 and 61737
Arkansas Medicaid·Identified Sep 10, 2025
Failed to analyze policy change
Medium impact
REVISED 2025 Quarter 3 Healthcare Common Procedure Coding System Level II (HCPCS) Code and Current Procedural Terminology (CPT) Code Conversion
Arkansas Medicaid·Identified Sep 4, 2025
Failed to analyze policy change
Medium impact
REVISED: New Edit for 340B Medical Billing
Arkansas Medicaid·Identified Jul 28, 2025
Failed to analyze policy change
Medium impact
Updates to Wheelchair Accessories Procedure Codes E1028 and E1032-E1034
Arkansas Medicaid·Identified Jul 21, 2025
Failed to analyze policy change
Medium impact
Inpatient Claims and Use of Condition Codes
Arkansas Medicaid·Identified Jul 15, 2025
Failed to analyze policy change
Medium impact
New Formula Procedure Codes and Formula Rate Changes - Effective 7/15/2025
Arkansas Medicaid·Identified Jul 1, 2025
Failed to analyze policy change
Medium impact
Prescribing Information for Durable Medical Equipment and Updates to Orthotic Procedure Codes L3204, L3206, and L3207
Arkansas Medicaid·Identified Jun 30, 2025
Failed to analyze policy change
Medium impact
REVISED - Obstetrics (OB) Services Billing Changes (Global/Itemized) and Postpartum Visits
Arkansas Medicaid·Identified Jun 26, 2025
Failed to analyze policy change

Arkansas Medicaid in AR Arkansas Medicaid: Cardiology Arkansas Medicaid: Family Medicine Arkansas Medicaid: General Practice Arkansas Medicaid: Genetics All payers

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Whole Exome Sequencing (WES) Clinical Criteria (CPT 81415, 81416, 81417)

2026 ICD10-PCS Revisions Effective 4/1/2026

Coverage for Casgevy (J3392) and Lyfgenia (J3394) for the Sickle Cell Gene Therapy Model

2026 Annual and Quarter 1 Healthcare Common Procedure Coding System Level II (HCPCS) Code, Current Procedural Terminology (CPT), and ASC Code Conversion

2026 ICD10-CM/PCS Revisions Effective 10/1/2025

Coverage for Procedure Codes 58300 and 58301

REVISED New Coverage - Presumptive Eligibility – Pregnant Women (PE-PW)

Prior Authorization required on Procedure Codes A4224 and A4225

Coverage Added for J0174 and J0175

Whole Genome Sequencing (WGS) Clinical Criteria (CPT 81425, 81426, 814271)

Act 515 - Allow Providers Additional Time to Respond to Adverse Decisions

Other Medical Service PA Process Type Now Available for Carved-Out Drugs and Services

Eating Disorder Services – No PCP Referral Required

Coverage for Home Sleep Study (Proc Codes 95800, 95801, and 95806)

New Coverage for B4100 U1 – SIMPLY THICK FOOD THICKENER ORAL - CONCENTRATE/1 OZ

Federal Revalidation Guidance from CMS

Updates to Skin Substitute Procedures

REVISED: Continuous Glucose Monitor (CGM) Systems and Supplies – Effective 6/1/2026

Physical Therapist Coverage for Nerve Conduction Study (NCS)

2026 Quarter 2 Healthcare Common Procedure Coding System Level II (HCPCS) Code and Current Procedural Terminology (CPT) Code Conversion

FQHC and RHC Billing Guidelines for Postpartum

REVISED: 2025 Quarter 2 Healthcare Common Procedure Coding System Level II (HCPCS) Code and Current Procedural Terminology (CPT) Code Conversion

Drugs and Services Carved Out of Physician Administered Drug Prior Authorizations Submitted to Prime Therapeutics

Coverage for Procedure Code D9245

Extension of Prior Authorization (PA) for Hyperalimentation Services if the Beneficiary has a Chronic Condition

Upcoming Changes to Prior Authorization Process for Physician-Administered Drugs – Effective January 1, 2026

REVISED: 2025 Quarter 4 Healthcare Common Procedure Coding System Level II (HCPCS) Code and Current Procedural Terminology (CPT) Code Conversion

Change to Prior Authorization Process for Physician-Administered Drugs – Effective January 1, 2026

Technical Denial Indicator for Prior Authorizations

2026 NUBC/UB04 Changes

Coverage for Procedure Codes 61736 and 61737

REVISED 2025 Quarter 3 Healthcare Common Procedure Coding System Level II (HCPCS) Code and Current Procedural Terminology (CPT) Code Conversion

REVISED: New Edit for 340B Medical Billing

Updates to Wheelchair Accessories Procedure Codes E1028 and E1032-E1034

Inpatient Claims and Use of Condition Codes

New Formula Procedure Codes and Formula Rate Changes - Effective 7/15/2025

Prescribing Information for Durable Medical Equipment and Updates to Orthotic Procedure Codes L3204, L3206, and L3207

REVISED - Obstetrics (OB) Services Billing Changes (Global/Itemized) and Postpartum Visits