Back to dashboard
MedicaidBilling CodesHigh impact

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

Arkansas Medicaid·AR · Pediatrics, Family Medicine, Internal Medicine +6 more·Coding
Effective date
Jul 1, 2025
We identified it
Sep 4, 2025
Days to comply
—

Summary

Arkansas Department of Human Services is updating HCPCS and CPT procedure codes effective July 1, 2025, with new codes becoming payable and terminated codes becoming non-payable. New vaccine codes (90612, 90613, 90635, 91323), injection codes (J0165, J0616, J0618, J1163, J1326, J2312, J2313, J3373-J3375, J7356, J9276, J9289, J9341, J9342, J9382), and specialty drug codes (C9174, C9175, Q2058, Q5098-Q5100, 0556U) are now payable across multiple provider types with specified age limits and prior authorization requirements. Providers must adjust claims for coding changes and recoup any overpayments from previously paid claims using terminated codes.

Action Required

Action needed
By June 30, 2025: Billing team must update billing system to activate new payable codes (90382, 90612, 90613, 90635, 91323, C9174, C9175, J0165, J0616, J0618, J1163, J1326, J2312, J2313, J3373-J3375, J7356, J9276, J9289, J9341, J9342, J9382, Q2058, Q5098-Q5100, 0556U) with corresponding age limits and modifiers (EP, TJ, SL where applicable). Configure system to require prior authorization for codes marked with 'Y' in PA column (C9174, C9175, J1326, J3391, J7356, J9276, J9289, J9382, Q2058, Q5098-Q5100). After June 30, 2025: Deactivate all terminated codes in billing system. Before 365-day filing deadline: Billing team must submit claim adjustments for any paid claims containing terminated codes to recover overpayments per Arkansas DHS instructions. Update provider documentation to include NDC billing protocol for all drug codes except radiopharmaceuticals, vaccines, and allergen immunotherapy. Notify all providers of changes and request PA revisions to approving entities as needed. Failure to implement changes will result in claim denials for dates of service after 6/30/2025 and potential overpayment recoupment.

Affected Billing Codes

90382
90612
90613
90635
91323
C9174
C9175
J0165
J0616
J0618
J1163
J1326
J2312
J2313
J3373
J3374
J3375
J7356
J9276
J9289
J9341
J9342
J9382
Q2058
Q5098
Q5099
Q5100