MedicaidCoverageHigh impact
Limitation Restrictions Removed for Non-Stress Tests and Ultrasounds
Arkansas Medicaid·AR · OB-GYN·Provider Notice
Effective date
Sep 1, 2026
We identified it
Aug 26, 2026
Summary
Effective September 1, 2026, Arkansas Department of Human Services removed prior authorization limitations for non-stress tests (CPT 59025) and fetal ultrasounds (CPT 76801-76828). Providers can now bill these procedures without hitting the previous two-per-nine-month-period cap, but must maintain documentation supporting medical necessity for all claims, which remain subject to retrospective review and recoupment.
Action Required
By September 1, 2026: Billing team must update billing system to remove quantity limits (audit codes 6374 and 6361) and EOB denial codes (0231 and 0064) that previously blocked claims for non-stress tests and fetal ultrasounds. Providers must implement documentation requirements to support medical necessity for all non-stress tests (CPT 59025) and fetal ultrasound claims (CPT 76801-76828); add documentation checklist to EMR templates or encounter forms to capture clinical justification. Inform clinical staff that these procedures no longer require prior authorization but that all claims remain subject to retrospective review and potential recoupment if documentation is insufficient. Update billing rules in system to process claims without automatic denials based on frequency limits.