Section 7 AAC 120.310 - Service authorization; prosthetic or orthotic items or services(a) A provider seeking service authorization must make a request electronically or in writing on a certificate of medical necessity.(b) Service authorization is required for (1) items or services indicated as requiring service authorization on the Alaska Medicaid DMEPOS Fee Schedules, Tables 1-5 through 1-9, adopted by reference in 7 AAC 160.900, including prosthetic or orthotic items or services;(2) medical supplies that exceed the maximum units or a 30-day limit set by the department;(3) items that are identified as miscellaneous in the United States Department of Health and Human Services, Centers for Medicare and Medicaid Services' (CMS) Healthcare Common Procedure Coding System (HCPCS), adopted by reference in 7 AAC 160.900, and that are not unique to prosthetics and customized orthotics;(4) prosthetic or orthotic items or services if the charge to the department is over $10,000; and(5) items or services that, based on medical necessity, may need to be replaced before the qualified time that the item or service would be allowed to be replaced otherwise, even if the item or service was not initially identified as requiring a service authorization.(c) A request for service authorization must be consistent with Medicare requirements where applicable and include, at a minimum, (1) a prescription order with a certificate of medical necessity completed by the enrolled ordering (B) physician assistant; or(C) advanced practice registered nurse; and(2) documentation by the person under (1) of this subsection that the item or service is necessary to treat, correct, or ameliorate a defect, condition, or physical or mental illness if the recipient is under 21 years of age.Eff. 6/2/2019, Register 230, May 2019 Authority:AS 47.05.010
AS 47.07.030
AS 47.07.040