016-06-04 Ark. Code R. § 82
The following procedure codes and any associated modifier(s) must be billed for DDS Alternative Community Services (ACS) Waiver Services. Prior authorization is required for all services.
National Code | M1 | M2 | PA | Description | Unit of Service | POS for Paper Claims | POS for Electronic Claims |
H2016 | Y | ACS Supported Living (Individual) | 1 Day | 4,0 | 12,99 | ||
H2016 | 52 | Y | ACS Supported Living (Group) | 1 Day | 4,0 | 12,99 | |
H20231 | Y | ACS Supported Employment | 15 Minutes | 0 | 99 | ||
T20282 | Y | ACS Specialized Medical Supplies | 1 Month | 4,0 | 12,99 | ||
T2022 | Y | ACS Case Management Services | 1 Month | 4,0 | 12,99 | ||
T20253 | Y | ACS Consultation Services | 1 Hour | 4,0 | 12,99 | ||
T2034 | Y | ACS Crisis Center Services | 1 Day | 0,4 | 99, 12 | ||
T20344 | U1 | 22 | Y | ACS Crisis Intervention Services | 1 Hour | 0,4 | 99, 12 |
1individuals are limited to a maximum of 32 units (8 hours) of supported employment services per date of service.
A breakdown of the supported employment units of service include:
One unit = 15 minutes to 21 minutes Two units = 22 minutes to 37 minutes Three units = 38 minutes to 52 minutes Four units = 53 minutes to 67 minutes
2Reimbursement cannot exceed $300 per month.
3individuals may receive twenty-five (25) hours of ACS consultation services per waiver-eligible year.
4 Crisis intervention services may require a maximum of 24 hours of service during any one day.
The following list contains the procedure codes used for ACS physical adaptations. Physical adaptations have a benefit limit of $7500 per year.
National Code | M1 | M2 | PA | Description | POS for Paper Claims | POS for Electronic Claims |
K0108 | Y | Other accessories | 4 | 12 | ||
S5160 | Y | Emergency response system; installation and testing | 4 | 12 |
S5161 | Y | Emergency response system; service fee, per month (excludes installation and testing) | 4 | 12 | ||
S5162 | Y | Emergency response system; purchase only | 4 | 12 | ||
S5165 | U1 | Y | Home modifications, per service | 4 | 12 |
Refer to Section 272.200 for definitions of the place of service codes listed above.
016.06.04 Ark. Code R. § 082