Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.05-076 - Podiatrist Provider Manual Update Transmittal #60

Current through Register Vol. 49, No. 6, June, 2024
SECTION II
- PODIATRIST
200.000
PODIATRIST GENERAL INFORMATION
201.000
Arkansas
			 Medicaid Participation Requirements for Podiatrists
201.100
Participation Requirements for
			 Individual Podiatrists
Podiatrists must meet the following criteria to be eligible to
				participate in the Arkansas Medicaid Program.
A. The provider must complete and submit to
			 the Medicaid Provider Enrollment Unit a provider application (form DMS-652), a
			 Medicaid contract (form DMS-653) and a Request for Taxpayer Identification
			 Number and Certification (Form W-9).
View or print a provider
			 application (form DMS-652), a Medicaid contract (form DMS-653) and a Request
			 for Taxpayer Identification Number and Certification (Form
			 W-9).
B.
			 Enrollment as a Medicaid provider is conditioned upon approval of a completed
			 provider application and the execution of a Medicaid provider contract. Persons
			 and entities that are excluded or debarred under any state or federal law,
			 regulation, or rule are not eligible to enroll, or to remain enrolled, as
			 Medicaid providers.
C. The provider
			 must be licensed to practice podiatrist's services in his or her state.
1. A copy of the current state license must
			 accompany the provider application and Medicaid contract.
2. A copy of subsequent state licensure
			 renewal must be forwarded to the Medicaid Provider Enrollment Unit within 30
			 days of issuance. If the renewal document(s) have not been received within this
			 timeframe, the provider will have an additional and final 30 days to
			 comply.
3. Failure to timely submit
			 verification of license renewal will result in termination of enrollment in the
			 Arkansas Medicaid Program.
D. The provider must submit Clinical
			 Laboratory Improvement Amendments (CLIA) certification, if applicable. (Section
			 205.000 contains information
			 regarding CLIA certification.)
201.200
Group Providers of
			 Podiatrists' Services
Group providers of podiatric services must meet the following
				criteria to be eligible for participation in the Arkansas Medicaid
				Program.
A. In order for a group of
			 podiatrists to have Arkansas Medicaid reimburse the group for the services of
			 its members, the group and the individual podiatrist must enroll in Arkansas
			 Medicaid.
1. Each podiatrist member of the
			 group who intends to treat Medicaid beneficiaries must enroll in accordance
			 with the requirements in section
			 201.100.
2. The group must also enroll in the Arkansas
			 Medicaid Program by completing and submitting to the Medicaid Provider
			 Enrollment Unit a provider application (form DMS-652), a Medicaid contract
			 (form DMS-653) and a Request for Taxpayer Identification Number and
			 Certification (Form W-9).
3.
			 Enrollment as a Medicaid provider is conditioned upon approval of a completed
			 provider application and the execution of a Medicaid provider contract. Persons
			 and entities that are excluded or debarred under any state or federal law,
			 regulation or rule are not eligible to enroll, or to remain enrolled, as
			 Medicaid Providers.
B.
			 All group providers are "pay to" providers
only
. The
			 service must be performed and billed by the performing licensed and enrolled
			 podiatrist with the group.
214.000
Benefit Limits
Medicaid-eligible patients are responsible for payment for
				services beyond the established benefit limits, unless the Division of Medical
				Services (DMS) contractor authorizes an extension of a particular benefit. If a
				Medicaid-eligible patient elects to receive a service for which DMS contractor
				has denied a benefit extension or for which DMS contractor subsequently denies
				a benefit extension, the patient is responsible for payment.
View or print the AFMC contact
				information.
215.100
Procedure for Obtaining
			 Extension of Benefits for Podiatry Services
A. Requests for extension of benefits for
			 podiatry services for beneficiaries under age 21 must be mailed to the Arkansas
			 Foundation for Medical Care, Inc. (AFMC).
View or print the
			 Arkansas Foundation for Medical Care, Inc., contact information.
A request for extension of benefits must meet the medical necessity
			 requirement, and adequate documentation must be provided to support this
			 request.
1. Requests for extension of benefits
			 are considered only after a claim is denied because the patient's benefit
			 limits are exhausted.
2. The
			 request for extension of benefits must be received by AFMC within 90 calendar
			 days of the date of the benefits-exhausted denial. The count begins on the next
			 working day after the date of the Remittance and Status Report (RA) on which
			 the benefits-exhausted denial appears.
3. Submit with the request a copy of the
			 Medical Assistance Remittance and Status Report reflecting the claim's denial
			 for exhausted benefits. Do not send a claim.
4. AFMC will not accept extension of benefits
			 requests sent via electronic facsimile (FAX).
B. Use form DMS-671, Request for Extension of
			 Benefits for Clinical, Outpatient, Laboratory and X-Ray Services, to request
			 extension of benefits for podiatry services.
View or print
			 form DMS-671
.
Consideration of
			 requests for extension of benefits requires correct completion of all fields on
			 this form. The instructions for completion of this form are located on the back
			 of the form. The provider's signature (with his or her credentials) and the
			 date of the request are required on the form. Stamped or electronic signatures
			 are accepted. All applicable records that support the medical necessity of the
			 extended benefits request should be attached.
C. AFMC will approve or deny an extension of
			 benefits request - or ask for additional information - within 30 calendar days
			 of their receiving the request. AFMC reviewers will simultaneously advise the
			 provider and the beneficiary when a request is denied.
215.110
Administrative Reconsideration
			 of Extension of Benefits Denial
A request for administrative reconsideration of an extension of
				benefits denial must be in writing and sent to AFMC within 30 calendar days of
				the denial. The request must include a copy of the denial letter and additional
				supporting documentation pursuant to 215.115.
The deadline for receipt of the reconsideration request will be
				enforced pursuant to sections
				190.012 and
				190.013 of this manual. A request
				received by AFMC within 35 calendar days of a denial will be deemed timely. A
				request received later than 35 calendar days gives rise to a rebuttable
				presumption that it is not timely.
215.115
Documentation Requirements
A. To request extension of benefits
			 for any benefit limited service, all applicable records that support the
			 medical necessity of extended benefits are required.
B. Documentation requirements are as follows.
1. Clinical records must:
a. Be legible and include records supporting
			 the specific request
b. Be signed by
			 the performing provider c. Include clinical, outpatient and/or emergency room
			 records for dates of service in chronological order
d. Include related diabetic and blood
			 pressure flow sheets
e. Include
			 current medication list for date of service
f. Include obstetrical record related to
			 current pregnancy
g. Include
			 clinical indication for laboratory and x-ray services ordered with a copy of
			 orders for laboratory and x-ray services signed by the physician
2. Laboratory and radiology
			 reports must include:
a. Clinical indication
			 for laboratory and x-ray services ordered b. Signed orders for laboratory and
			 radiology services c. Results signed by performing provider d. Current and all
			 previous ultrasound reports, including biophysical profiles and fetal
			 non-stress tests
215.130
Appealing an Adverse Action
Please see section
				190.000
et al.
for information regarding administrative appeals.
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.
A. Procedure codes for podiatry services
			 provided in a nursing home or skilled nursing facility are listed in section
			 242.110.
B. Procedure codes for podiatry services
			 requiring prior authorization are listed in section
			 242.120.
C. Procedure codes payable to podiatrists for
			 laboratory and X-ray services are located in section
			 242.130.
D. Procedure code
99238,
Hospital Discharge Day Management, may not be billed by providers in
			 conjunction with an initial or subsequent hospital care code (procedure codes
99221
through
99233).
Initial hospital care codes and
			 subsequent hospital care codes may not be billed on the day of
			 discharge.
E. In addition to the
			 CPT codes shown below,
T1015, a
HCPCS code, is payable to
			 podiatrists.
F. Procedure code
99353
must be billed for a service provided in a beneficiary's
			 home.
The listed procedure codes and their descriptions are located
				in the
Physician's Current Procedural Terminology (CPT)
book.
				Section III of the Podiatrist Manual
				contains information on how to purchase a copy of the CPT publication.
Procedure Codes
J7340
10060
10061
10120
10140
10160
10180
11000
11040
11041
11042
11043
11044
11055
11056
11057
11100
11200
11201
11420
11421
11422
11423
11424
11426
11620
11621
11622
11623
11624
11626
11719
11720
11721
11730
11732
11740
11750
11752
11760
11762
12001
12002
12004
12020
12021
12041
12042
12044
13102
13122
13131
13132
13153
13160
14040
14350
15000
15001
15050
15100
15101
15120
15121
15220
15221
15240
15241
15342
15343
15620
15999*
16000
16010
16015
17000
17003
17004
17110
17111
17999*
20000
20005
20200
20205
20206
20220
20225
20240
20500
20501
20520
20525
20550
20551
20552
20553
20600
20605
20612
20615
20650
20670
20680
20690
20692
20693
20694
20900
20910
20974
20975
27605
27606
27610
27612
27620
27625
27626
27648
27650
27654
27687
27690
27695
27696
27698
27700
27702
27703
27704
27792
27808
27810
27814
27816
27818
27822
27823
27840
27842
27846
27848
27860
27870
27888
27889
28001
28002
28003
28005
28008
28010
28011
28020
28022
28024
28030
28035
28043
28045
28046
28050
28052
28054
28060
28062
28070
28072
28080
28086
28088
28090
28092
28100
28102
28103
28104
28106
28107
28108
28110
28111
28112
28113
28114
28116
28118
28119
28120
28122
28124
28126
28130
28140
28150
28153
28160
28171
28173
28175
28190
28192
28193
28200
28202
28208
28210
28220
28222
28225
28226
28230
28232
28234
28238
28240
28250
28260
28261
28262
28264
28270
28272
28280
28285
28286
28288
28290
28292
28293
28294
28296
28297
28298
28299
28300
28302
28304
28305
28306
28307
28308
28310
28312
28313
28315
28320
28322
28340
28341
28344
28345
28360
28400
28405
28406
28415
28420
28430
28435
28436
28445
28450
28455
28456
28465
28470
28475
28476
28485
28490
28495
28496
28505
28510
28515
28525
28530
28540
28545
28546
28555
28570
28575
28576
28585
28600
28605
28606
28615
28630
28635
28645
28660
28665
28666
28675
28705
28715
28725
28730
28735
28737
28740
28750
28755
28760
28800
28805
28810
28820
28825
28899
29345
29355
29358
29365
29405
29425
29435
29440
29445
29450
29505
29515
29520
29540
29550
29580
29750
29893
29894
29895
29897
29898
29899
29999*
64450
64550
64704
64782
73592
73600
73610
73615
73620
73630
73650
73660
82962
87070
87101
87102
87106
87184
93922
93923
93924
93925
93926
93930
93931
93965
93970
93971
95831
95851
99201
99202
99203
99204
99205
99211
99212
99213
99214
99215
99221
99222
99223
99231
99232
99233
99238
99241
99242
99243
99244
99245
99251
99252
99253
99254
99255
99271
99272
99273
99281
99282
99283
99284
99301
99302
99303
99341
99342
99343
99347
99348
99349
99353
T1015
*Procedure codes 15999, 17999 and 29999 are manually priced and
				require an operative report.
242.440
Bilaminate Graft or Skin
			 Substitute Procedures
Arkansas Medicaid reimburses podiatrists who furnish the
				manufactured viable bilaminate graft or skin substitute. The product is
				manually priced and requires paper claims using procedure code
J7340,
type of service code 1. The manufacturer's invoice and the operative
				report must be attached.
Application procedures of bilaminate skin substitute are
				payable to the podiatrist using procedure codes
15342
and
15343.
These codes must be listed separately when filing claims.
				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 procedure
				codes will continue to require prior authorization.
Surgical preparation procedures using procedure codes
15000
and
15001
may be reimbursed when performed at
				the same surgical setting. These codes must be listed separately in addition to
				the primary procedure and do not require PA.