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. 6, June, 2024
SECTION II
- PROSTHETICS
212.213
(DME) Specialized Wheelchairs and Wheelchair Seating Systems for
			 Individuals Two (2) Years of Age and Older
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
12. Prescribed drugs, dentures, and
			 prosthetic devices; and eyeglasses prescribed by a physician skilled in
			 diseases of the eye, or by an optometrist
c.
			 Prosthetic Devices
(6) Orthotic Appliances
			 and Prosthetic Devices
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.