MedicaidPrior AuthHigh impact
Skin Substitution Code Changes
Arkansas Medicaid·AR · Plastic Surgery, Wound Care, Podiatry +2 more·Coding
Effective date
Aug 21, 2026
We identified it
Aug 22, 2026
Summary
Effective August 21, 2026, Arkansas Medicaid now requires prior authorization for nine skin substitute procedure codes across ASC, physician, podiatrist, and prosthetics providers due to fraud and abuse concerns flagged by HHS-OIG. Additionally, reimbursement for skin substitute codes will be bundled into primary surgery codes for most provider types, eliminating separate payment for these materials.
Action Required
By August 21, 2026: (1) Billing team must update billing system to require prior authorization submission to Arkansas Foundation for Medical Care (AFMC) for codes A2011, A2012, C9363, Q4101, Q4102, Q4104, Q4105, Q4107, Q4108, and Q4121 before claims are submitted. (2) Reconfigure reimbursement rules in billing software to bundle the following codes into primary surgery reimbursement and prevent separate billing: A2011, A2012, C9358, C9363, Q4101, Q4102, Q4104, Q4105, Q4107, Q4108, Q4111, Q4141, Q4150 (all provider types); add C9359, Q4113, Q4114, Q4116, Q4145 to bundled list for ASC contracts only. (3) Update provider encounter forms and clinical workflows to identify skin substitute use at point of service for prior auth documentation. (4) Configure system to route all skin substitute claims through prior authorization workflow before billing. (5) Train billing and clinical staff on new requirements. Contact AFMC at 1-800-426-2234 (toll-free) or (479) 649-8501 for prior authorization submissions. Failure to obtain prior authorization will result in claim denials; failure to bundle codes will result in payment recapture.