MedicaidBilling CodesHigh impact
Prescribing Information for Durable Medical Equipment and Updates to Orthotic Procedure Codes L3204, L3206, and L3207
Arkansas Medicaid·AR · Orthopedics, Pediatrics, Physical Therapy +1 more·Provider Notice
Effective date
Jul 1, 2025
We identified it
Jun 30, 2025
Summary
Effective July 1, 2025, Arkansas updated HCPCS codes L3204, L3206, and L3207 for pediatric and youth orthopedic shoes with supinator/pronator support. The U1 modifier is discontinued for these codes and replaced with EP (children ages 0-20) and NU (adults 21+) modifiers. Additionally, Act 431 of 2025 expands prescribing authority for DME/orthotics to include Nurse Practitioners and Physician Assistants, not just physicians.
Action Required
By June 30, 2025: Billing team must update billing system to discontinue use of U1 modifier for codes L3204, L3206, and L3207. Replace all future claims using these codes with either EP modifier (for patients ages 0-20) or NU modifier (for patients 21+). Update claim scrubbing rules to reject any L3204/L3206/L3207 claims submitted with U1 modifier on or after July 1, 2025. Notify providers that Nurse Practitioners and Physician Assistants are now authorized prescribers for DME/orthotics under Act 431, and update credentialing/authorization forms accordingly. Communicate changes to front-desk staff regarding patient eligibility verification. Failure to implement modifier changes will result in claim denials for pediatric and youth orthopedic shoe prescriptions.