Arkansas Administrative Code
Agency 016 - DEPARTMENT OF HUMAN SERVICES
Division 29 - Division of Medical Services
Rule 016.29.22-009 - Prosthetics Rate Review - State Plan Amendment (SPA) and Prosthetics Prvider Manual
Current through Register Vol. 49, No. 9, September, 2024
SECTION II - PROSTHETICS
Arkansas Medicaid covers specialized wheelchairs and wheelchair seating systems for individuals two (2) years of age and older.
Some items of specialized equipment require prior authorization from DHS or its designated vendor. View or print form DMS-679 and instructions for completion. View or print contact information for how to submit the request.
ATTACHMENT 4.19-B
Page 4c
STATE PLAN UNDER TITLE XIX OF THE SOCIAL SECURITY ACT MEDICAL ASSISTANCE PROGRAMSTATE OF ARKANSAS
METHODS AND STANDARDS FOR ESTABLISHING PAYMENT RATESOTHER TYPES OF CARE
Revised: January 1, 2023
Reimbursement is based on the lesser of the amount billed or the Title XIX (Medicaid) maximum charge allowed. State developed fee schedule rates are the same for both public and private providers of orthotic appliances and prosthetic devices.
Effective for dates of service occurring on and after September 1, 2006, reimbursement rate maximums for Medicaid covered orthotic appliances and prosthetic devises are based on one hundred percent (100%) of the 2006 DMEPOS Medicare rates.
For the following procedure codes not reflecting a rate on the 2006 DMEPOS Medicare fee schedule, reimbursement rate maximums for dates of service occurring September 1, 2006, and after, will be based on one hundred percent (100%) of the 2006 Arkansas Blue Cross/Blue Shield rate:
A5510 = $30.28, L0452 = $263.81, L3202 = $51.21, L3204 = $50.12, L3206 = $51.93, L3207 = $52.67, L3208 = $28.58, L3209 = $39.53, L3211 = $42.11, L3215 = $93.94, L3216 = $113.29, L3219 = $105.26, L3221 = $126.00, L3222 = $139.22, L3230 = $163.33, L3250 = $331.47, L3253 = $44.64, L3257 = $32.95, L3265 = $20.54, L3902 = $1,980.19, L4205 = $35.00, L4210 = $28.27, L7500 = $67.55, L7520 = $15.00
Effective for dates of service on or after January 1, 2023, reimbursement rate maximums for orthotic appliances and prosthetic devices will be set at ninety percent (90%) of the January 1, 2022 Medicare non-rural rate for the State of Arkansas. For orthotic and prosthetic codes not listed on the Medicare fee schedule, reimbursement rate maximums for dates of service on or after January 1, 2023, will be set at eighty percent (80%) of the January 1, 2022, Arkansas Blue Cross/Blue Shield rate, or manually priced.
All rates are published on the agency's website Fee Schedules - Arkansas Department of Human Services. Except as otherwise noted in the plan, state developed fee schedule rates are the same for both governmental and private providers.
