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016.06.48-242.160 Durable Medical Equipment, All Ages

AR ADC 016.06.48-242.160Arkansas Administrative CodeEffective: February 1, 2022

West's Arkansas Administrative Code
Title 016. Department of Human Services
Division 06. Division of Medical Services
Rule 48. Prosthetics Provider Manual (Refs & Annos)
Section 242.000. CMS-1500 Billing Procedures.
Section 242.100. HCPCS Procedure Codes.
Effective: February 1, 2022
Ark. Admin. Code 016.06.48-242.160
016.06.48-242.160 Durable Medical Equipment, All Ages
Procedure codes found in this section must be billed either electronically or on paper with modifier EP for beneficiaries under 21 years of age or modifier NU for beneficiaries age 21 and older. When a second modifier is listed, that modifier must be used in conjunction with either EP or NU. Modifier UE is required when billing for used equipment.
Modifiers in this section are indicated by the headings M1 and M2. Prior authorization requirements are shown under the heading PA. If prior authorization is needed, that information is indicated with a “Y” in the column; if not, an “N” is shown.
* The purchase of wheelchairs for individuals age 21 and older is limited to one per five-year period.
*** This procedure code may not be billed for used equipment.
◆ Prior authorization is not required when other insurance pays at least 50% of the Medicaid maximum allowable reimbursement amount.
-(...) This symbol, along with text in parentheses, indicates the Arkansas Medicaid description of the product. When using a procedure code with this symbol, the product must meet the indicated Arkansas Medicaid description.
3 This item is a capped rental for 90 days only, and requires PA and a review.
View or print the procedure codes and modifiers for Durable Medical Equipment (DME), oxygen equipment and supplies, orthotic appliances, prosthetic devices and medical supplies, procedures and services.
Procedure codes must be billed when hospital beds are purchased for Medicaid beneficiaries of all ages. Providers must only provide these purchase-only services to beneficiaries who are expected to require the bed for a long period of time. Each procedure code for hospital beds listed above may only be billed once every 10 years.
Procedure codes must also be used to bill for equipment that does not meet the purchase-only criteria. They are reimbursed on a capped rental basis. The capped rental items must be used until the equipment is no longer repairable or until it is no longer appropriate for the beneficiary as verified by the physician.

Credits

Amended Nov. 1, 2017; Feb. 1, 2022.
<Editor’s Note: Nonfunctioning links so in original.>
Current with amendments received through May 15, 2024. Some sections may be more current, see credit for details.
Ark. Admin. Code 016.06.48-242.160, AR ADC 016.06.48-242.160
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