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

Arkansas Medicaid·AR · Oncology, Cardiology, Internal Medicine +4 more·Coding
Effective date
Apr 1, 2026
We identified it
Apr 30, 2026
Days to comply
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Summary

Arkansas Medicaid is implementing new HCPCS and CPT procedure codes effective April 1, 2026, while simultaneously terminating four codes (C9145, C9307, C9308, L6000, L6010, L6020). Billing teams must update systems to recognize new payable codes by provider type, implement new prior authorization requirements for specific codes, and process mass adjustments to recoup any claims paid with terminated codes after March 31, 2026.

Action Required

Action needed
By March 31, 2026: Billing team must (1) Update billing system to recognize new payable codes (C9309, J0463, J1164, J3404, J8502, J9183, J9277, J9278, J9601, Q5161, Q5162, A4318, A6548, L5992) with appropriate provider type restrictions and prior authorization requirements as documented in Section II; (2) Configure prior authorization mandates in billing software for codes C9309, J3404, J8502, J9183, J9277, J9601, Q5161, Q5162, A6548, and L5992 (NU modifier) based on provider contract type; (3) Implement age and diagnosis group restrictions in billing system for relevant codes (e.g., J9277 requires age 12+; J9278 requires diagnosis group 603 for ages 21+); (4) Stop accepting claims on or after April 1, 2026 using terminated codes C9145, C9307, C9308, L6000, L6010, L6020—flag these as non-payable; (5) Prepare for mass claim adjustments: identify all claims paid with terminated codes for dates of service after March 31, 2026 and initiate recoupment process per Arkansas DHS requirements; (6) Submit all claim adjustments and revisions to prior authorizations before the 365-day filing deadline; (7) For drug procedure codes, ensure NDC billing protocol is applied (exemptions: radiopharmaceuticals, vaccines, allergen immunotherapy); (8) Educate billing staff and providers on new code utilization and PA requirements. Failure to implement these changes will result in claim denials and recoupment of improperly paid claims.

Affected Billing Codes

C9309
C9145
C9307
C9308
J0463
J1164
J3404
J8502
J9183
J9277
J9278
J9601
Q5161
Q5162
A4318
A6548
L5992
L6000
L6010
L6020