016.06.05 Ark. Code R. 023
Codes
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.
Procedure 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 | UB | 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 | o, | 4 | 99, 12 | ||
T20344 | U1 | UA | Y | ACS Crisis Intervention Services | 1 Hour | o, | 4 | 99, 12 |
individuals 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
Reimbursement cannot exceed $300 per month.
individuals may receive twenty-five (25) hours of ACS consultation services per waiver-eligible year.
The following list contains the procedure codes used for ACS physical adaptations. Physical adaptations have a benefit limit of $7500 per year.
Procedure 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.
016.06.05 Ark. Code R. 023