MedicaidBilling CodesHigh impact
New Formula Procedure Codes and Formula Rate Changes - Effective 7/15/2025
Arkansas Medicaid·AR·Coding
Effective date
Jul 15, 2025
We identified it
Jul 1, 2025
Summary
Effective July 15, 2025, Arkansas Medicaid (MEDSP) is adding two new enteral feeding supply codes (B4034, B4036) and updating reimbursement rates for multiple hyperalimentation and prosthetics formula procedure codes. Providers must now request and bill supplies separately from formula on distinct detail lines, though current authorizations will be honored until new prescriptions allow separate authorization and billing.
Action Required
By July 15, 2025: Billing team must update billing system to recognize new HCPCS codes B4034 ($3.65) and B4036 ($5.04) and require prior authorization for both codes. Update all formula procedure code rates in billing system per the rate tables provided (B4035 through B9002 vary by modifier and provider type 16 or 33). Modify billing workflow to require supplies and formula to be billed on separate detail lines for all new authorizations and single case agreements. Update claim templates and encounter forms to enforce separate line-item billing. For dates of service before July 15, 2025, continue honoring existing authorizations that combine formula and supplies on single lines. After July 15, 2025, all new or renewal authorizations must be requested and billed separately. Train billing staff on new codes, rates, and modifiers (EP, U1, U7, U8, U9 variations) to ensure accurate claim submission. Failure to comply will result in claim denials and payment delays.