Alaska Administrative Code
Title 7 - Health and Social Services
Part 8 - Medicaid Coverage and Payment
Chapter 120 - Medicaid Coverage; Prescription Drugs and Medical Supplies; Durable Medical Equipment; Prosthetics and Orthotics Transportation Services
Article 2 - Durable Medical Equipment and Medical Supplies; Related Services
7 AAC 120.310 - Service authorization; prosthetic or orthotic items or services
Universal Citation: 7 AK Admin Code 120.310
Current through November 28, 2024
(a) A provider seeking service authorization must make a request electronically or in writing on a certificate of medical necessity.
(b) Service authorization is required for
(1) items or services indicated as requiring
service authorization on the Alaska Medicaid DMEPOS Fee Schedules,
Tables 1-5 through 1-9, adopted by reference in
7
AAC 160.900, including prosthetic or orthotic items or
services;
(2) medical supplies that
exceed the maximum units or a 30-day limit set by the department;
(3) items that are identified as
miscellaneous in the United States Department of Health and Human Services,
Centers for Medicare and Medicaid Services' (CMS) Healthcare Common
Procedure Coding System (HCPCS), adopted by reference in
7
AAC 160.900, and that are not unique to prosthetics
and customized orthotics;
(4)
prosthetic or orthotic items or services if the charge to the department is
over $10,000; and
(5) items or
services that, based on medical necessity, may need to be replaced before the
qualified time that the item or service would be allowed to be replaced
otherwise, even if the item or service was not initially identified as
requiring a service authorization.
(c) A request for service authorization must be consistent with Medicare requirements where applicable and include, at a minimum,
(1) a prescription order with a
certificate of medical necessity completed by the enrolled ordering
(A) physician;
(B) physician assistant; or
(C) advanced practice registered nurse;
and
(2) documentation by
the person under (1) of this subsection that the item or service is necessary
to treat, correct, or ameliorate a defect, condition, or physical or mental
illness if the recipient is under 21 years of age.
Authority:AS 47.05.010
AS 47.07.030
AS 47.07.040
Disclaimer: These regulations may not be the most recent version. Alaska may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
This site is protected by reCAPTCHA and the Google
Privacy Policy and
Terms of Service apply.
