MedicaidPrior AuthMedium impact
Updated Coverage for Procedure Code J0638
Arkansas Medicaid·AR · Pharmacy·Pharmacy
Effective date
Jun 26, 2026
We identified it
Jun 28, 2026
Summary
Arkansas has updated coverage requirements for HCPCS procedure code J0638, specifically establishing new prior authorization requirements in the pharmacy category. The billing team must implement prior authorization workflows for this code effective immediately.
Action Required
By June 26, 2026: Billing team must update billing software and prior authorization system to require prior authorization for HCPCS code J0638 before claim submission. Verify the specific medical necessity criteria in the full policy document at https://humanservices.arkansas.gov/wp-content/uploads/ON-021-26.docx. Configure encounter forms and provider alerts to notify staff that J0638 now requires prior auth. Train billing staff on the prior auth process. Failure to obtain prior authorization will result in claim denials for Arkansas Medicaid members.