Arkansas Administrative Code
Agency 016 - DEPARTMENT OF HUMAN SERVICES
Division 06 - Medical Services
Rule 016.06.08-027 - Podiatrist Provider Manual Update Transmittal #102

201.100 Participation Requirements for Individual Podiatrists

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

202.000 Medicare Mandatory Assignment of Claims for Physician's Services

The Omnibus Budget Reconciliation Act of 1989 requires the mandatory assignment of Medicare claims for "physician" services furnished to individuals who are eligible for Medicare and Medicaid, including those eligible as Qualified Medicare beneficiaries (QMBs). According to Medicare regulations, "physician" services, for the purpose of this policy, are services furnished by physicians, dentists, optometrists, chiropractors and podiatrists.

When a beneficiary 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 beneficiary cannot be billed for the charges. See Section 142.700 for detailed information regarding Medicare participation and Sections 332.000 through 332.300 for detailed information regarding Medicare-Medicaid Crossover Claim procedures.

NOTE: The podiatrist provider must notify the Provider Enrollment Unit of a

Medicare identification number. View or print Provider Enrollment Unit contact information.

211.000 Introduction

212.000 Scope

214.100 New Patient Visit

Providers are allowed to bill one new patient visit procedure code per beneficiary, per attending provider in a three (3) year period.

214.200 Medical Visits and Surgical Services

The Arkansas Medicaid Program covers two medical visits per state fiscal year (July 1 through June 30) for medical services provided by a podiatrist in an office, a beneficiary's home or in a nursing facility for eligible beneficiaries age 21 and over. Benefit extensions may be granted in cases of documented medical necessity.

Medical visits for individuals under the age of 21 in the Child Health Services (EPSDT) Program do not have a benefit limit.

Surgical services provided by a podiatrist are not included in the two visits per state fiscal year (SFY) benefit limit for individuals age 21 and over.

215.000 Extension of Benefits

Benefit extensions may be requested in the following situations:

221.300 Post-Authorization

Post-authorization will be granted only for emergency procedures and/or retroactively eligible beneficiaries. Requests for emergency procedures must be applied for on the first working day after the procedure has been performed. In cases of retroactive eligibility, AFMC must be contacted for post-authorization within 60 days of the authorization date.

242.100 Procedure Codes

Sections 242.100 through 242.120 list the procedure codes payable to podiatrists. Any special billing or other requirements are described in parts A through F of this section and in sections 242.110 and 242.120.

242.410 Completion of Forms for Medicare/Medicaid Deductible and