The Arkansas Medicaid fee schedule sets the maximum the state will pay for each covered procedure code, and the program reimburses whichever is lower: your billed charge or that listed maximum. Everything else about getting paid correctly builds on that rule.
Where to Find the Current Schedule
The Division of Medical Services (DMS) inside the Arkansas Department of Human Services publishes and maintains every Medicaid fee schedule.1Arkansas Department of Human Services. About DMS – Division of Medical Services The files live on the DHS site at Home → Divisions & Shared Services → Division of Medical Services → Helpful Information for Providers → Fee Schedules.2Arkansas Department of Human Services. Fee Schedules
Schedules are organized 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 file carries a “run date” indicating when its data was generated. Confirm you are working from the most recent run date before you bill.
A separate Procedure Code Tables page lists every code currently payable, along with its effective date.3Arkansas Department of Human Services. Procedure Code Tables Use it to verify a code is active before submission, especially after the annual CPT and HCPCS conversions that take effect each January.
How to Read a Fee Schedule Row
Each row represents one billable service identified by a CPT or HCPCS code.4Arkansas State Legislature. Notice of Rulemaking 2016 CPT and HCPCS Code Conversion The columns you will see on most schedules:
- Procedure Code: the five-character CPT or HCPCS code.
- Modifier columns: one or two columns showing any required modifier that must accompany the code.5Arkansas Department of Human Services. 2020 HCPCS Code Conversion Official Notice
- Unit: how the service is measured for payment, such as one unit per injection or 15-minute increments for therapy.
- Medicaid Maximum Allowed Amount: the highest dollar figure the program will pay for one unit.
The payment rule is straightforward. Arkansas Medicaid pays the lesser of your billed charge or the listed maximum.6Cornell Law School Legal Information Institute (LII). 016.27.21 Ark Code R 005 – Arkansas Medicaid Procedure Code Linking Table Project Bill $150 on a code with a $90 maximum and you get $90. Bill $80 and you get $80. Billing above the maximum is standard and triggers no penalty; the program simply pays its posted rate.
Some rows 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 individually from documentation or cost reports rather than a flat rate.
What Changes the Actual Payment
The listed maximum is rarely the last word. Several factors move the number up, down, or to zero.
Modifiers
Modifiers are two-character codes appended to a procedure code that tell the claims system something specific about how the service was delivered. Some raise payment, such as those flagging service in an underserved area. Others cut it, such as multiple-procedure discounts or professional-component-only billing. A single procedure code can appear on multiple rows with different modifier combinations, each carrying its own maximum.5Arkansas Department of Human Services. 2020 HCPCS Code Conversion Official Notice
Prior Authorization
Certain services require prior authorization before treatment. Deliver a PA-required service without one and the claim can be denied outright regardless of the fee schedule rate. The list changes periodically, and DMS announces additions and removals through official notices and provider manual updates.7Cornell Law School Legal Information Institute (LII). 016.27.21 Ark Code R 005 – Arkansas Medicaid Procedure Code Linking Table Project Verify PA requirements before scheduling, particularly for surgery, imaging, DME, and certain drugs.
NCCI Edits
Even with valid rates on every code, National Correct Coding Initiative (NCCI) edits can block payment on certain combinations. These federally maintained rules stop payment for services that should not be billed together on the same date of service for the same patient.8Centers for Medicare & Medicaid Services (CMS). Medicaid NCCI Coding Policy Manual Introduction Each edit pairs a Column One code with a Column Two code; when both appear together for the same beneficiary and date, only Column One pays. A clinically appropriate modifier can override the denial where the edit allows it, but the provider must document why both codes were medically necessary.
Managed Care Patients Are Not on This Schedule
A large share of Arkansas Medicaid beneficiaries receive coverage through managed care, and managed care plans are not bound by the DMS fee schedule at all.
The ARHOME program (Arkansas Health and Opportunity for Me) replaced Arkansas Works on January 1, 2022, using Medicaid dollars to buy private coverage through Blue Cross Blue Shield or Ambetter for eligible adults.9Arkansas Department of Human Services. ARHOME – Arkansas Health and Opportunity for Me Providers bill the carrier, not DMS, and reimbursement follows the carrier’s contracted rates.
The PASSE program (Provider-Led Arkansas Shared Savings Entity) covers Medicaid members with complex behavioral health, developmental, or intellectual disabilities.10Arkansas Department of Human Services. PASSE – Provider-Led Arkansas Shared Savings Entity Each PASSE negotiates its own provider rates, which can differ substantially from the DMS schedule.
If you serve both fee-for-service and managed care patients, you are working under multiple fee schedules. Verify which program covers each patient before billing.
Providers Paid Outside the Standard Schedule
A few provider types don’t use the per-procedure schedule at all. Federally Qualified Health Centers and Rural Health Clinics are typically paid under a Prospective Payment System (PPS) or an encounter rate: a per-visit payment covering all qualifying services in a single encounter, regardless of how many procedure codes the visit would otherwise generate. The rate is adjusted annually and is generally higher than fee-for-service billing at schedule rates would produce.
Hospitals serving a disproportionately large share of Medicaid and uninsured patients may qualify for Disproportionate Share Hospital (DSH) payments, supplemental amounts on top of standard reimbursement. Federal law caps each state’s annual DSH allotment and also imposes a hospital-specific limit tied to eligible uncompensated care costs. Since October 2021, that hospital-specific limit counts only costs and payments where Medicaid is the primary payer, which tightened the calculation for many facilities.11Medicaid.gov. Medicaid Disproportionate Share Hospital (DSH) Payments
Filing Deadlines and Prompt Payment
Providers must submit Medicaid claims within 12 months (365 days) from the date of service.12Arkansas Department of Human Services. What Is Timely Filing Miss that deadline and the claim is dead. No fee schedule rate matters if the claim never lands in time.
On the state’s side, federal law imposes its own clocks. Arkansas Medicaid must pay at least 90 percent of clean practitioner claims within 30 days of receipt, and 99 percent within 90 days.13eCFR. 42 CFR 447.45 – Timely Claims Payment A clean claim is one processable without asking the provider or a third party for more information. Claims under fraud investigation or medical necessity review don’t count. If your clean claims are routinely taking longer than 30 days, that’s worth escalating.
How and When Rates Change
Rates are date-of-service effective. The rate in effect the day you delivered the service is the rate that applies, not the rate the day you submit the claim.7Cornell Law School Legal Information Institute (LII). 016.27.21 Ark Code R 005 – Arkansas Medicaid Procedure Code Linking Table Project During a transition, services before the change date get the old rate; services after get the new one.
DMS is not locked into an annual cycle. It can update rates quarterly or at any time to implement policy changes, add or delete codes, or correct pricing errors. Announcements come through Official Notices and provider manual updates on the DHS site. Register with the state’s Medicaid program to receive electronic notifications so a rate change doesn’t reach you three months late.
Federal-level changes to the payment methodology require a State Plan Amendment submitted to CMS. CMS then has 90 days to approve, deny, or request more information; if it requests more information, the 90-day clock restarts when the state responds.14eCFR. 42 CFR Part 430 Subpart B – State Plans
One change worth flagging: starting July 1, 2026, CMS will require every state to publish all fee-for-service Medicaid payment rates on a publicly accessible website, along with a comparison of Medicaid rates against Medicare for primary care, OB-GYN, and outpatient mental health and substance use services, refreshed at least every two years.15Centers for Medicare & Medicaid Services. Ensuring Access to Medicaid Services Final Rule CMS-2442-F The first comparison uses Medicaid rates in effect on July 1, 2025 against Medicare’s 2025 physician fee schedule.16Federal Register. 17Arkansas Department of Health. Medicaid Provider Appeals
The deadline is tight. Submit your fair hearing request within 30 calendar days of the date on the adverse action notice.17Arkansas Department of Health. Medicaid Provider Appeals Requests go by mail, fax, or email to the Arkansas Department of Health’s Medicaid Provider Appeals unit. Miss the 30-day window and the denial is final, so build a system that flags adverse notices the day they arrive.
Overpayment disputes have their own path. Federal rules require the state to issue a final written notice giving the provider a chance to contest the determination before formal recovery begins.18eCFR. 42 CFR Part 433 Subpart F – Refunding of Federal Share of Medicaid Overpayments to Providers Filing an appeal does not pause the clock on the discovery date for overpayment purposes, so move quickly either way.