1915(c) HCBS fee schedule, prior authorization and invoice requirements — Arkansas
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Defines covered HCBS service codes, modifiers, units, fee schedules, prior authorization and invoice requirements for CareSource members in Arkansas under the 1915(c) program effective January 1, 2026.
Benefit Limit change effective with updated Fee Schedule.
Coverage criteria and billing rules
Coverage criteria and billing rules
Authorization, documentation, and limit rules for selected HCPCS codes:
ALL of the following
ALL of the following
ALL of the following
- Transportation fee examples: $0.52 per mile for individual transport and $0.26 per mile for multi‑member transport as shown on the fee schedule.
Covered codes and limits
| H2016 | Complex Care Homes; Supportive Living (low/moderate/exceptional/enhanced need); Shared Staffing; unit/unit rates vary by modifier and descriptor |
| H2023 | Supported Employment - Individual and Group (15 min units); fee schedule entries present |
| S5151 | Care Giver Respite Services (1:1 and shared staffing; 15 min units) with different rates for durations |
| K0108 | Environmental Modification; combined annual cap with adaptive equipment |
| S5160 | Adaptive Equipment PERS installation/testing (pass-thru cost) |
| S5161 | Adaptive Equipment PERS monthly service fee (pass-thru cost) |
| S5162 | Adaptive Equipment PERS purchase, rental & repair (pass-thru cost) |
| S5165 | CES Adaptive Equipment, per service (pass-thru cost) |
| T2025 | Consultation Services - Behavior Support Plans/Training, psychological/adaptive assessments, staff/family training; hourly; invoice required |
Authorization, invoicing and provider requirements
Prior Authorization Required for Pass‑Through SMS/Equipment
Certain pass‑through costs for Specialized Medical Supplies/Equipment (SMS) must be prior authorized and an invoice must be attached to the authorization request. Failure to obtain prior authorization or to attach the required invoice may result in claim denial or payment delay.
T2025 Consultation Prior Authorization and Invoice Rule
For T2025 consultation services: no prior authorization is required for the first unit. However, all consultation requests require an invoice to be attached. PCSP participation and treatment planning are limited to 2 hours per event, and an annual combined maximum of $1,320 applies across all T2025 consultation codes.
- Rates up to $136.40 per hour.
- 2 hour maximum per PCSP participation or treatment planning event.
- Invoice must be attached for every consultation request beyond the first unit and for audit/claim support.
Definitions and pass-through cost notes
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