1915(c) Home and Community‑Based Services (HCBS) fee schedule and authorizations
Defines billing codes, modifiers, units, fee schedule amounts, authorization and invoice requirements for HCBS services under the 1915(c) program applicable to CareSource members in Arkansas (AR). Affects providers billing supportive living, supported employment, respite, consultation, adaptive equipment, environmental modifications, and related pass-through services.
Fee schedule amounts and effective/termination dates updated for multiple H2016 service levels and other HCBS codes.
Authorization and invoice requirements clarified for consultation (T2025) and pass‑through costs (T2020, S5160-S5162, S5165) with annual combined limits.
A combined annual cap of $12,000 (and references to $1,320 annual max for T2025 group) for specified adaptive equipment / consultation / pass-through services.
Authorization & Coverage Rules
Authorization and Invoice Requirements for Consultations and Pass‑through Services
Rules governing prior authorization, invoice submission, and annual limits for consultation (T2025) and pass-through items (T2020, S5160–S5162, S5165, K0108/UB).
ALL of the following
Consultation (T2025)
- First unit: No prior authorization required; invoice must be attached for payment; billed per hour up to S136.40/hour; up to 2 hours allowed for PCSP participation or treatment planning.
- Additional units: Prior authorization required; all consultation units combined subject to an annual maximum of $1,320 per member (inclusive of all T2025 consultation requests).
Pass‑through cost items (adaptive equipment, PERS, environmental modifications, supplemental support, community transition)
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