Arkansas
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
State Contact Information
Elizabeth Pitman
Director of the Division of Medical Services for the Medicaid Program
Elizabeth.Pitman@dhs.arkansas.gov
501-244-3944
https://humanservices.arkansas.gov/divisions-shared-services/medical-services/contact-dms-2/
General Genetic Testing Criteria
The Arkansas Medicaid Program covers a wide variety of procedure codes regarding genetic services.
Procedure codes can be found at https://humanservices.arkansas.gov/divisions-shared-services/medical-services/helpful-information-for-providers/proc-codes/ and choosing the “Independent Laboratory” table.
Genetic Testing Not Covered
State Specific Definition
Genetic Services for Children
Genetic Counseling Requirement
Licensed Genetic Counselor Information Packet: https://www.armedicalboard.org/Professionals/pdf/LGC.pdf
Prenatal Diagnosis Counseling must be performed by a maternal fetal medicine physician or a staff member under his or her direct supervision. This service includes, but is not limited to:
- Family, medical, pregnancy history
- Psychosocial assessment and counseling of couple regarding genetic testing and disorder
- Diagnosis, prognosis, available options, pregnancy management are explained to the couple.
Metabolic Formula Coverage Legislation
Arkansas
ACA §20‐15‐304
ACA §23‐79‐701 et seq.
AAR §17‐16‐07‐001
Metabolic Formula Coverage & Criteria
Coverage of sole source enteral therapy must be prior approved. Enteral (sole source) nutrition is considered medically necessary for a patient with a functioning gastrointestinal tract who cannot maintain weight and strength commensurate with his or her general condition due to pathology or non-function of the structures that normally permit food to reach the digestive tract. Enteral (sole source) therapy may be given by nasogastric, jejunostomy or gastrostomy tubes.
Coverage of enteral (sole source) nutrition therapy must be prior approved. Each request will be reviewed on a case by case basis.
Hyperalimentation services are provided to beneficiaries at their place of residence. “Place of residence” is defined as the beneficiary’s own dwelling, an apartment, a relative’s home or a boarding home. Hyperalimentation services in the beneficiary’s place of residence may be covered only when the therapy is determined to be medically necessary for the patient and is prescribed by a physician.
Enteral formulae are divided into several categories. Each unit of service equals one-hundred (100) calories of formula. All supplies and equipment necessary to administer the nutrients in the beneficiary’s place of residence, except the infusion pump and pump supply kit, are included in the unit description.
An EPSDT screening, which documents the PCP’s medical rationale for prescribing a formula, as well as medical records documenting the beneficiary’s failed trials of WIC formula, must be submitted for review. Flavor preference for formulae will not be considered for medical necessity.
A separate prior authorization must be obtained for the enteral infusion pump and the pump supply kit. The enteral infusion pump and the pump supply kit may be billed separately.
Prior Authorization Requirements
Most, but not all genetic tests require prior authorization. Refer to the Independent Laboratory table to learn what tests require PA.
Prior Authorization Forms
Fee Schedule
BRCA Testing Coverage
There is coverage for the following:
- Next-generation sequencing of breast cancer profiling 70 content genes and 31 housekeeping genes
- Test for detecting genes associated with inherited breast cancer-related disorders
- Gene analysis (breast and related cancers), duplication or deletion variants
- Test for detecting genes associated with cancer
- Test for detecting genes associated with breast cancer
Requirements for BRCA
Cystic Fibrosis Screening
Coverage is available, but criteria is unknown.
Hereditary Cancer Testing Coverage
- Test for detecting genes associated with colon cancer, duplication/deletion analysis panel, at least 5 genes
- Test for detecting genes associated with colon cancer, genomic sequence analysis panel, at least 10 genes
- Test for detecting genes associated with cancer of body organ
- Test for detecting genes associated with cancer
Lynch Syndrome Testing Coverage
Coverage is available, but criteria is unknown.
Microarray Testing
- Genome-wide microarray analysis for copy number variants (0-6 years old)
- Genome-wide microarray analysis for copy number and single nucleotide polymorphism variants (0-6 years old)
- Genome-wide microarray analysis for copy number and loss-of-heterozygosity variants
Newborn Screening
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.
Panel Testing
Coverage is available, but criteria is unknown.
Pharmacogenetic Testing
Arkansas Medicaid covers genomic sequence analysis panel of at least 6 genes associated with drug metabolism
Prenatal Testing Offered
Test for detecting genes associated with fetal disease, aneuploidy genomic sequence analysis panel
Whole Exome Sequencing
- Test for detecting exome, sequence analysis
- Test for detecting exome, sequence analysis, each comparator exome
- Reevaluation test of previously obtained exome sequence
Other Tests Covered
- Test for detecting genes associated with heart disease, genomic sequence analysis panel, at least 9 genes
- Test for detecting genes associated with heart disease, duplication/deletion analysis panel
- Test for detecting genes for disorders related to Ashkenazi Jews, genomic sequence analysis panel, at least 9 genes
- Test for detecting genes associated with heart disease, genomic sequence analysis panel, at least 10 genes
- Gene analysis panel for evaluation of genes associated with epilepsy
- Test for detecting genes causing hearing loss, duplication/deletion analysis panel
- Gene analysis (retinal disorders), genomic sequence
- Test for detecting genes associated with inherited disease of heart muscle
- Gene sequence analysis panel at least 30 genes associated with inherited bone marrow failure syndromes
- Gene analysis (Noonan Syndrome) genomic sequence analysis
- Genomic sequence analysis panel for severe inherited conditions with sequencing of 15 or more genes
- Test for detecting genes associated with cancer of body organ
- Test for detecting genes associated with blood related cancer
- Targeted genomic sequence analysis panel of rna of 5-50 genes associated with blood and lymphatic system disorders
- Targeted genomic sequence analysis panel of rna of 51 or greater genes associated with blood and lymphatic system disorders
- Test for detecting genes associated with disease, genomic sequence, must include sequence analysis of entire mitochondrial genome
- Test for detecting genes associated with disease, whole mitochondrial genome
- Test for detecting genes associated with heart diseases
Other Information
Resources
Newborn Screening Reimbursement
On this Page
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.