Help Desks / Support Centers

(800) 457-4454
in-state toll-free or
(501) 376-2211
local and out-of-state

Arkansas Payment Improvement Initiative
(866) 322-4696 in-state toll-free or
(501) 301-8311 local and out-of-state

Magellan Medicaid Administration Pharmacy Help Desk
(800) 424-7895, Option 2 for Prescribers

Long Term Care Codes

Updated 1/28/19
If you are billing for Long Term Care services, you need the following codes, which are used only for Long Term Care.

Type of Bill
(First and Second Digits)
Description
21 Skilled Nursing Facility (SNF) Inpatient
22 Skilled Nursing Facility (SNF) Inpatient, Part B
23 Skilled Nursing Facility (SNF) Outpatient
65 Intermediate Care Facility (ICF) Intermediate Care-I
66 Intermediate Care Facility (ICF) Intermediate Care-II
81 Special Facility Non-Hospital / Hospice
82 Special Facility Hospital / Hospice

Type of Bill
(3rd Digit)
Description
1 Admit Through Discharge Claim
2 Interim – First Claim
3 Interim – Continuing Claims
4 Interim – Last Claim
8 Void/Cancel of a Prior Claim

Patient Status Description
01 Discharged to Home or Self Care
02 Discharged/Transferred to Another Short-Term General Hospital
03 Discharged/Transferred to SNF
04 Discharged/Transferred to an Intermediate Care Facility (ICF)
05 Discharged/Transferred to Another Type of Institution
06 Discharged/Transferred to Home Under Care of Organized
Home Health Service Organization
07 Left Against Medical Advice
20 Expired
30 Still Patient

Homestyle Revenue Code Description Unit of Service
184 LOA HOME – Home Style Facility 1 Day
186 LOA Hospital 85% or Greater Occupancy – Home Style Facility 1 Day
187 LOA Hospital Less than 85% Occupancy – Home Style Facility 1 Day
188 LOA No Pay – Home Style Facility 1 Day
199 Home Style Facility All LOC 1 Day
659 Hospice Room and Board – Home Style Bed 1 Day

Traditional Style
Revenue Code
Description Unit of Service
180 LOA Hospital less than 85% occupancy – Traditional Style Bed or ICF/IID 1 Day
183 LOA – Home – Traditional Style Bed or ICF/IID 1 Day
185 LOA Hospital 85% or greater occupancy – Traditional Style Bed or ICF/IID 1 Day
189 LOA No Pay – Traditional Style Bed or ICF/IID 1 Day
190 Skilled Nursing – Traditional Style Bed 1 Day
191 Intermediate I – Traditional Style Bed 1 Day
192 Intermediate II – Traditional Style Bed 1 Day
193 Intermediate III – Traditional Style Bed 1 Day
194 ICF/IID 1 Day
658 Hospice Room and Board – Traditional Style Bed or ICF/IID 1 Day