Arkansas Administrative Code
Agency 016 - DEPARTMENT OF HUMAN SERVICES
Division 06 - Medical Services
Rule 016.06.05-002 - Transportation Update #61- Medicaid Participation Requirements

Podiatrists must meet the following criteria to be eligible to participate in the Arkansas Medicaid Program.

Group providers of podiatric services must meet the following criteria to be eligible for participation in the Arkansas Medicaid Program.

Podiatrists in Arkansas and the six bordering states (Louisiana, Mississippi, Missouri, Oklahoma, Tennessee and Texas) may be enrolled as routine services providers if they meet all Arkansas Medicaid participation requirements outlined in Section 201.100.

Routine Services Providers

Podiatrists in non-bordering states may be enrolled only as limited services providers.

Limited Services Providers

Limited services providers may be enrolled in the program to provide "emergency" or "prior authorized" services only.

Emergency services are defined as inpatient or outpatient hospital services that a prudent layperson with an average knowledge of health and medicine would reasonably believe are necessary to prevent death or serious impairment of health and which, because of the danger to life or health, require use of the most accessible hospital available and equipped to furnish those services.

Source: 42 U.S. Code of Federal Regulations § 422.2 and § 424.101.

Prior authorized services are those services that are medically necessary and not available in Arkansas. Each request for these services must be made in writing and mailed to the Arkansas Division of Medical Services, Utilization Review Section and approved before the service is provided. View or print the Arkansas Division of Medical Services, Utilization Review Section contact information. An Arkansas Medicaid contract must be signed before reimbursement can be made

Limited services provider claims will be manually reviewed prior to processing to ensure that only emergency or prior authorized services are approved for payment. These claims should be mailed to the Arkansas Division of Medical Services Program Communications Section. View or print the Arkansas Division of Medical Services Program Communications Section contact information.

Podiatrists have the option of enrolling in the Title XVIII (Medicare) Program in order to be eligible for participation in the Arkansas Medicaid Program as providers of podiatrist's services. When a recipient is dually eligible for Medicare and Medicaid and is provided services that are covered by both Medicare and Medicaid, Medicaid will not reimburse for those services if Medicare has not been billed prior to Medicaid billing. The recipient cannot be billed for the charges. Claims filed by Medicare "non-participating" providers do not automatically cross over to Medicaid for payment of deductibles and coinsurance.

The following list of procedure codes must be used to bill for a podiatrist's services. Several procedure codes from the list below are payable only in situations described in separate sections.

The following codes require prior authorization before services may be provided.

*Effective for dates of service on and after October 1, 2004, CPT procedure codes 15342 and 15343 do not require prior authorization when the diagnosis is burn injury (ICD-9-CM code range 940.0 through 949.5). All other diagnoses requiring the use of these procedures will continue to require prior authorization.