Page 2479

Common Procedure Coding System (HCPCS), adopted by reference in 7 AAC 160.900, and that are not unique to prosthetics and customized orthotics;

(4) prosthetic or orthotic items or services if the charge to the department is over $10,000; and

(5) items or services that, based on medical necessity, may need to be replaced before the qualified time that the item or service would be allowed to be replaced otherwise, even if the item or service was not initially identified as requiring a service authorization. (c) A request for service authorization must be consistent with Medicare requirements where applicable and include, at a minimum,

(1) a prescription order with a certificate of medical necessity completed by the enrolled ordering

(A) physician;

(B) physician assistant; or

(C) advanced practice registered nurse; and

(2) documentation by the person under (1) of this subsection that the item or service is necessary to treat, correct, or ameliorate a defect, condition, or physical or mental illness if the recipient is under 21 years of age. (Eff. 6/2/2019, Register 230) Statutory Authority: Authority: AS 47.05.010 AS 47.07.030 AS 47.07.040 7 AAC 120.399. Definitions. In 7 AAC 120.200 — 7 AAC 120.399,

(1) “capped rental” means the rental of durable medical equipment for not more than 13 months;

(2) “custom fabricated orthotic” means an orthotic that is individually made for a specific patient and created using measurements or an impression generally by means of plaster or fiber cast, a digital image using computer aided design-computer aided manufacture (CADCAM) systems software, or direct form to patient;