Arkansas Medicaid Fee Schedule: Rates, Modifiers, and Appeals

The Arkansas Medicaid fee schedule sets the maximum the program will pay for each covered service, and Arkansas Medicaid reimburses the lesser of your billed charge or that maximum. The schedule is published by the Division of Medical Services (DMS) within the Arkansas Department of Human Services, organized by provider type, and updated throughout the year rather than only at the start of each calendar year. Knowing the rate is only the start: modifiers, correct-coding edits, prior authorization, managed care enrollment, and filing deadlines all shape what you actually collect.

Where to Find the Current Schedule

DMS hosts every fee schedule on the DHS website under Divisions & Shared Services → Division of Medical Services → Helpful Information for Providers → Fee Schedules.¹ Files are grouped by provider type: physician, dental, pharmacy, inpatient hospital, outpatient hospital, durable medical equipment, and others. Most are downloadable as PDFs or Excel spreadsheets, and each one carries a “run date” showing when the data was generated. Confirm you are working from the most recent run date before billing.

A separate Procedure Code Tables page lists every procedure code currently payable along with its effective date.² Use it to verify a code is still active, especially after the annual CPT and HCPCS code conversions that take effect each January.

How to Read a Rate Row

Each row represents a single billable service identified by a CPT or HCPCS code. The columns you will see most often are the procedure code, one or two modifier columns, the unit of measure (per injection, per 15 minutes of therapy, and so on), and the Medicaid maximum allowed amount.³

The payment rule is straightforward. Bill $150 for a service with a $90 maximum and you get $90. Bill $80 and you get $80.⁴ Billing above the maximum is normal and carries no penalty; the program simply pays its listed rate.

Some codes show a $0.00 maximum. That does not mean the service is unpaid. It signals manual pricing by the Medicaid fiscal agent, usually because the service is priced from documentation or cost reports rather than a flat rate.

What Actually Changes the Payment

The schedule maximum is rarely the end of the story. Several factors move the final number up, down, or to zero.

Modifiers

Modifiers are two-character codes appended to a procedure code to describe how the service was performed. Some increase payment, such as those indicating service in an underserved area. Others reduce it, including multiple-procedure discounts and professional-component-only billing. The same procedure code can appear on several rows of the schedule with different modifier combinations, each carrying a different maximum.³

NCCI Edits

Even when every code on a claim has a valid rate, the National Correct Coding Initiative (NCCI) edits can block payment for certain combinations. NCCI pairs a Column One code with a Column Two code; when both appear on the same claim for the same beneficiary and date, only Column One pays and Column Two is denied.⁵ A clinically appropriate modifier can override some edits, but the record has to support why both codes were reported.

Prior Authorization

Certain services require prior authorization (PA) before treatment. Deliver a PA-required service without the authorization and the claim can be denied in full, no matter what the schedule says. The list changes periodically, and DMS communicates additions and removals through Official Notices and provider manual updates.⁶ Verify PA requirements before scheduling surgery, imaging, DME, and certain prescription drugs.

ARHOME and PASSE Managed Care

A large share of Arkansas Medicaid beneficiaries receive coverage through managed care, and managed care plans are not bound by the DMS fee schedule.

The ARHOME program (Arkansas Health and Opportunity for Me) replaced Arkansas Works on January 1, 2022, and uses Medicaid dollars to purchase private insurance through Blue Cross Blue Shield or Ambetter for eligible adults.⁷ Providers serving ARHOME members bill the private carrier at the carrier’s contracted rates.

The PASSE program (Provider-Led Arkansas Shared Savings Entity) covers Medicaid beneficiaries with complex behavioral health, developmental, or intellectual disabilities. Each PASSE negotiates its own provider rates, which can differ substantially from the DMS schedule.⁸ If you see both fee-for-service and managed care patients, you are effectively working under multiple fee schedules. Verify which program covers each patient before billing.

When the Standard Schedule Does Not Apply

Some provider types are paid under entirely separate methodologies that override the per-procedure rates.

FQHCs and Rural Health Clinics

Federally Qualified Health Centers and Rural Health Clinics are typically paid under a Prospective Payment System (PPS) or an encounter rate. The clinic receives a per-visit payment covering all qualifying services during a single encounter, regardless of how many codes the visit would otherwise generate. The rate adjusts annually and is generally higher than what the clinic would collect by billing each service at fee schedule rates.

Disproportionate Share Hospitals

Hospitals serving a disproportionately large share of Medicaid and uninsured patients may qualify for Disproportionate Share Hospital (DSH) payments on top of standard reimbursement. Federal law caps each state’s annual DSH allotment and also limits any single hospital’s DSH payments to its eligible uncompensated care costs.⁹

Filing Deadlines and Prompt Payment

The schedule rate does not matter if the claim never gets in the door. Providers must submit Medicaid claims within 12 months (365 days) of the date of service.¹⁰ Miss that window and the claim is dead.

On the state’s side, federal law requires Arkansas Medicaid to pay at least 90 percent of clean claims from practitioners within 30 days of receipt, and 99 percent within 90 days.¹¹ A clean claim is one that can be processed without requesting more information from the provider or a third party. Claims under fraud investigation or medical necessity review do not count. Clean claims consistently sitting past 30 days are worth escalating.

How Updates Happen

Rates are date-of-service effective. The rate in effect the day you provided the service applies, not the rate the day you submit the claim.⁶ During transition periods, services before the change date get the old rate and services after get the new one.

Updates are not confined to an annual cycle. DMS can change rates quarterly or at any point to implement policy changes, add or delete codes, or correct pricing errors. The primary communication channels are Official Notices and provider manual updates on the DHS website. Register with the state’s Medicaid program to receive electronic notifications when new notices post; finding out about a rate change months late means rework.

At the federal level, changes that alter the state’s Medicaid payment methodology require a State Plan Amendment (SPA) submitted to CMS. CMS has 90 days after receiving a SPA to approve it, deny it, or request more information. If CMS requests more information, the 90-day clock restarts when the state responds.¹²

Public Rate Transparency Starting July 2026

Beginning July 1, 2026, CMS requires every state to publish all fee-for-service Medicaid payment rates on a publicly accessible website. States must also publish a comparison showing how their Medicaid rates for primary care, OB-GYN, and outpatient mental health and substance use services measure against Medicare, updated at least every two years.¹³ The initial comparison uses Medicaid rates in effect July 1, 2025, measured against the 2025 Medicare physician fee schedule.¹⁴ Once published, these comparisons give provider associations and individual practices an official benchmark for advocating rate changes.

Appealing a Denial or Short Payment

When a claim is denied or paid at an amount you believe is wrong, you can request a fair hearing. Arkansas Medicaid providers may contest adverse decisions on claim payment, level of care, coding, medical necessity, prior authorization denials, and audit findings.¹⁵

The deadline is 30 calendar days from the date on the adverse action notice.¹⁵ Requests go to the Arkansas Department of Health’s Medicaid Provider Appeals unit by mail, fax, or email. Miss the window and the denial becomes final, so flag adverse notices the day they arrive.

For overpayment disputes specifically, federal rules require the state to issue a final written notice allowing the provider to contest the determination before formal recovery begins.¹⁶ Appealing does not pause the discovery-date clock for overpayment purposes, so move quickly regardless of whether you plan to challenge the finding.

1
Arkansas Department of Human Services. Fee Schedules
2
Arkansas Department of Human Services. Procedure Code Tables
3
Arkansas Department of Human Services. 2020 HCPCS Code Conversion Official Notice
4
Cornell Law School Legal Information Institute (LII). 016.27.21 Ark Code R 005 – Arkansas Medicaid Procedure Code Linking Table Project
5
Centers for Medicare & Medicaid Services (CMS). Medicaid NCCI Coding Policy Manual Introduction
6
Cornell Law School Legal Information Institute (LII). 016.27.21 Ark Code R 005 – Arkansas Medicaid Procedure Code Linking Table Project
7
Arkansas Department of Human Services. ARHOME – Arkansas Health and Opportunity for Me
8
Arkansas Department of Human Services. PASSE – Provider-Led Arkansas Shared Savings Entity
9
Medicaid.gov. Medicaid Disproportionate Share Hospital (DSH) Payments
10
Arkansas Department of Human Services. What Is Timely Filing
11
eCFR. 42 CFR 447.45 – Timely Claims Payment
12
eCFR. 42 CFR Part 430 Subpart B – State Plans
13
Centers for Medicare & Medicaid Services. Ensuring Access to Medicaid Services Final Rule CMS-2442-F
14
Federal Register. Medicaid Program Ensuring Access to Medicaid Services
15
Arkansas Department of Health. Medicaid Provider Appeals
16
eCFR. 42 CFR Part 433 Subpart F – Refunding of Federal Share of Medicaid Overpayments to Providers