Arkansas Administrative Code
Agency 016 - DEPARTMENT OF HUMAN SERVICES
Division 06 - Medical Services
Rule 016.06.06-039 - Visual Care Transmittal Update #78
Current through Register Vol. 49, No. 9, September, 2024
Section II Visual Care
|
Brand |
Frame |
Gender |
Size |
Colors |
|
Europa |
M-005 |
Unisex |
44&46 |
Antique Burgundy, and Gun/Matte Black |
|
Kip |
Women's |
48 |
Black and Crystal |
|
|
NF-1 |
Women's |
44&46 |
Red, and Antique Dark Green |
|
|
NF-3 |
Unisex |
44&46 |
Matte,Black and Mette Silver |
|
|
NF-5 |
Children's |
39-41-43 |
Brown, Blue, Gunmetal and Gold |
|
|
Shannon |
Women's |
46 |
Violet, Grey, Gold and Blue |
|
|
Carmen |
Unisex |
44-46-48 |
Matte Brown, Matte Gray, Ant. Gold tort. & Vio. |
|
|
L-Cable |
Children's |
36-38-40 |
Brown, Gold and Black |
|
|
NF-2 |
Unisex |
45&47 |
Matte,Black and Mette Blue |
|
|
NF-4 |
Children's |
38-40-42 |
Brown, Blue and Light Purple |
|
|
NF-9 |
Unisex |
46&48 |
Gray Matte and Brown Metallic |
|
|
NF-11 |
Men's |
52&54 |
Brown, Black, and Gunmetal |
|
|
Ken mark |
G531 |
Unisex |
45-47 |
Brown, Black and Matte Gold |
|
Andrea |
Women's |
49 |
Rose, Brown and Wne |
|
|
Shannon |
Women's |
46-48 |
Sand, Black and Lavender |
|
|
Sharon |
Women's |
49 |
Black Crystal and Brown |
|
|
Blaire |
Women's |
50-52 |
Golden Rose, Nutmeg and Dove |
|
|
Jay |
Men's |
48-50 |
Brown, Black and Gray |
|
|
Sam |
Men's |
49-51 |
Brown, Gunmetal and Black |
|
|
Jamie |
Women's |
44-46 |
Black/Yellow, Brown and Eine |
|
|
Henry |
Men's |
52-54-56-58 |
Gold, Gold/Demi Amber & Gunmetal/Tortoise |
|
|
Chet |
Men's |
54-56 |
Brown and Gunmetal |
|
|
Jed |
Men's |
51-53 |
Brown, Black and Gray |
|
|
Steve |
Men's |
52-54-56 |
Gray Fade, Demi Amber, Brown Fade & Black |
|
|
Gwen |
Women's |
51-53 |
Beige, Blush and Mist |
|
|
Louise |
Women's |
50-52 |
Brown, Sky and Violet |
|
|
United |
Destiny |
Unisex |
47 |
Coffee, C2 Matte Black and C3 Matte Silver |
|
Steve |
Men's |
49-51 |
C1 Brown, and C2 Dark Gray |
|
Stella |
Women's |
51 |
C1 Light Brown C2 Lilac and C3 Matte Silver |
|
|
Candy |
Unisex |
45 |
C1 Shiny Brown and C2 Matte Black |
|
|
Modern |
Sporty |
Kids |
44-46 |
Black/Crystal, Blue and Brown |
|
Gift |
Women's |
47-49 |
Black/Crystal, Brown/Crystal & Purple/Brown |
|
|
Dazzle |
Women's |
49-51-53 |
Brown, Gold And Rose |
|
|
Judi |
Women's |
50-53 |
Black/Crystal, Tortoise and Wne/Gray |
|
|
Dynamite |
Girl's |
42-45-47 |
Antique Brown and Black Silver |
|
|
Zimco |
Attitudes#3 |
Women's |
50 |
Brown/Crystal and Black |
|
Retro#1 |
Women's |
48 |
Gold, Gunmetal Blue and Matte Brown |
|
|
Hart |
Hart-9756 |
Women's |
48 |
Brown, Gold and Gunmetal Silver |
|
Hart-8103 |
Men's |
50 |
Gunmetal, Brown and Black |
|
|
Hart-8112 |
Unisex |
48 |
Matte Black, Mattee Burgundy & Matte Coffee |
|
|
Hart-5634 |
Women's |
47 |
Black Crystal and Brown Smoke |
|
|
Hart-5670 |
Women's |
48 |
Burgundy and Tortoise |
|
|
Hart-7771 |
Men's |
54 |
Bordfeaux and Coffee |
|
|
Hart-5695 |
Girl's |
47 |
Tortoise, Rose and Black |
|
|
Hart-5221 |
Unisex |
46 |
Blue, Brown and Lilac |
|
|
Hart-9751 |
Women's |
48-50 |
Brown, Silver and Lilac |
|
|
Hart 9509 |
Boy's |
38-41-44 |
Gold Brown,Satin Blue and Shiny Brown |
|
|
LBI |
Woman Day |
Woman's |
55 |
Gold, Rose and Gray |
|
LBI-915 |
Woman's |
53 |
Gold/Silver, Silver Gold and Brown/Gold |
Prosthetic providers that bill procedure codes V2623 or V2624 electronically must use a type of service (TOS) H with an NU modifier. Prosthetic providers billing either of the above procedure codes on paper must also use a TOS H with an NU modifier.
