Arkansas

Updated on February 10, 2023

This data is meant to be used for educational purposes to inform providers, patients, insurers, and state Medicaid agencies what genetic services may or may not be written into each state’s Medicaid policy. The database is not meant to indicate or imply whether a certain program will cover a specific service, since many decisions are made on a case by case basis. If you have specific questions about whether a service is covered, you should reach out to your plan administrator. Please see this disclaimer below for more information.

Medicaid Coverage Information Published

Yes

State Contact Information

Elizabeth Pitman Director of the Division of Medical Services for the Medicaid Program

Elizabeth.Pitman@dhs.arkansas.gov

501-244-3944

General Genetic Testing Criteria

Genetic Testing Not Covered

State Specific Definition

Genetic Services for Children

Hereditary/Metabolic Screening to be performed at age 1 month, if not performed either during the newborn evaluations or at the preferred age of 3-5 days.

Metabolic screening (e.g. thyroid, hemoglobinopathies, PKU, galactosemia) should be done according to state law.

Reimbursement for Child Health Services (EPSDT) screens, immunizations and lab procedures is based on the lesser of the billed amount or the Medicaid maximum.

Genetic Counseling Requirement

Metabolic Formula Coverage Legislation

Metabolic Formula Coverage & Criteria

Prior Authorization Requirements

The statement of medical necessity should indicate one of the following:

Patient failed to understand the prenatal screening consent form;
Patient’s risk on her prenatal screening result is higher than her chronologic age;
Patient has an abnormal ultrasound and is offered an amniocentesis or chorionic villus sampling procedure;
Patient is discovered to have a risk for a prenatally detectable genetic or chromosomal abnormality, metabolic disease, or neural tube defect not known at the time of the prenatal screen;
Patient has significant anxiety regarding her risk of a genetic defect despite a negative prenatal screen; or
Patient will be 35 years old at the time of delivery and remains concerned regarding her risk of a genetic defect.

Prior Authorization Forms

https://arkansas.magellanrx.com/provider/documents

Fee Schedule

https://humanservices.arkansas.gov/wp-content/uploads/LAB-fees.pdf

BRCA Testing Coverage

Requirements for BRCA

Cystic Fibrosis Screening

Hereditary Cancer Testing Coverage

Lynch Syndrome Testing Coverage

Microarray Testing

Newborn Screening

<p>Arkansas Code §20-15-302 states that all newborn infants shall be tested for phenylketonuria, hypothyroidism, galactosemia, cystic fibrosis and sickle cell anemia. Arkansas Medicaid shall reimburse the enrolled Arkansas Medicaid hospital provider that performs the tests required for the cost of the tests. Newborn Metabolic Screenings performed inpatient are included in the interim per diem reimbursement rate and facility cost settlement. For Newborn Metabolic Screenings performed in the outpatient setting (due to retesting or as an initial screening), Arkansas Medicaid will reimburse the hospital directly. For the screenings performed in the outpatient hospital setting, the provider will submit a claim using procedure code S3620. All positive test results shall be sent immediately to the Arkansas Department of Health.</p>

Panel Testing

Pharmacogenetic Testing

Prenatal Testing Offered

The Arkansas Medicaid Program covers prenatal screening for fetal anomalies using maternal serum HCG and AFP.

Whole Exome Sequencing

Other Tests Covered

Other Information

Resources

Provider Documents, Independent Laboratory, Section II, 292.560 Genetic Services https://humanservices.arkansas.gov/divisions-shared-services/medical-services/helpful-information-for-providers/manuals/lab-prov/
Provider Documents, Hyperalimentation, Section II, 242.120 https://humanservices.arkansas.gov/divisions-shared-services/medical-services/helpful-information-for-providers/manuals/hyper-prov/

Newborn Screening Reimbursement

Disclaimer: The information contained in the database has been obtained from sources believed to be reliable but NCC has not attempted to validate or confirm the information. The database may be updated periodically. However, the accuracy and completeness of the information contained in the database cannot be, and is not, guaranteed. NCC makes no warranty of the accuracy, completeness or timeliness of this information, and shall not be liable for any decision made in reliance on this information. It is the user’s responsibility to verify this information by contacting the state Medicaid agency directly.

The database contains links to third-party websites. These links are provided solely as a convenience to users and not as a guarantee, warrantee, or recommendation by NCC of the content on such third-party websites or as an indication of any affiliation, sponsorship or endorsement of such third party websites. NCC is not responsible for the content of linked third-party sites and does not make any representations regarding the privacy practices of, or the content or accuracy of materials on, such third-party websites. If you decide to access linked third-party websites, you do so at your own risk. Your use of third-party websites is subject to the terms of use for such sites.