MedicaidCoverageMedium impact
Updated Coverage for Procedure Codes J2789 and 0402T
Arkansas Medicaid·AR · Ophthalmology, Pharmacy·Pharmacy
Effective date
Jul 1, 2026
We identified it
Oct 1, 2026
Summary
Arkansas Medicaid has added coverage for two procedure codes effective July 1, 2026: J2789 (Riboflavin Epioxa/HD) and 0402T (Collagen Cross-Link Cornea & Pachymetry). Both codes require prior authorization for inpatient and outpatient services and are limited to patients age 13+. Prior claims processed before coverage activation will be reviewed for retroactive processing.
Action Required
By June 30, 2026: Billing team must update claims processing system to recognize J2789 and 0402T as covered codes for Arkansas Medicaid (both MEDSV and OUTPA contracts). Configure system to require prior authorization for both codes when submitted. Add age verification rule (13+ years only) to claims edits. Update provider encounter forms and templates to alert providers that prior authorization is mandatory before service delivery. Contact Arkansas Foundation for Medical Care at 1-800-426-2234 or https://reviewpoint.afmc.org/s/login/ to establish prior authorization submission process. For corneal procedures (0402T), note that Medical Review is not required; for Riboflavin (J2789), Medical Review is required. Failure to obtain prior authorization will result in claim denials.