Outpatient Hospital Fee Schedule Reference Extract
Current Reference Extracts

This section contains the current table extracts in HTML and Microsoft Excel formats. Clicking on the respective links will open the related documents in your browser. To return to this page, please use your browser's back button.

Current Reference Extracts for the following tables are available.
Table# Table Description How used in relation to the outpatient hospital fee schedule project.
See "How used..." Valid OPFS procedure modifiers AHCCCS standards for applicable OPFS procedure modifiers are consistent with and based upon current UBEditor Ingenix values. Any questions or concerns should be submitted to the AHCCCS OPFS workgroup.
See "How used..." OPFS CCI relationships AHCCCS standards for applicable OPFS CCI relationships are consistent with and based upon current UBEditor Ingenix values, with the additions on the attached document (AHCCCS Specific OPFS CCI Relationships). Any questions or concerns should be submitted to the AHCCCS OPFS workgroup.
RF723 Limit override modifiers Provides a list of modifiers which when billed on any applicable HCPCS/CPT on an outpatient hospital claim or encounter, require exception processing (such as override of service limits) as defined by the action code.
RF739 OPFS bundled exception procedures Provides a list of HCPCS/CPT codes which when billed on an outpatient hospital claim or encounter, require exception processing (such as not being subject to surgery bundling) as defined by the action code.
See "How used..." RF773 Revenue codes to procedure codes Provides a listing of HCPCS/CPT that can be reported for a revenue code.

October 2008 Extract:
RF773 0001-0299 [PDF] [MS-Excel]
RF773 0300-0350 [PDF] [MS-Excel]
RF773 0351-0399 [PDF] [MS-Excel]
RF773 0400-0499 [PDF] [MS-Excel]
RF773 0500-0511 [PDF] [MS-Excel]
RF773 0512-0514 [PDF] [MS-Excel]
RF773 0515-0517 [PDF] [MS-Excel]
RF773 0518-0599 [PDF] [MS-Excel]
RF773 0600-3109 [PDF] [MS-Excel]
See "How used..." RF774 Revenue codes to bill types Establishes relationships between revenue codes and type of bill that they can be utilized on, and for outpatient claims and encounters flags those revenue codes which require and/or allow reporting of HCPCS/CPT codes.

October 2008 Extract:
RF774 0001-0499 [PDF] [MS-Excel]
RF774 0500-3109 [PDF] [MS-Excel]
RF789 Multiple surgery exception table Provides a listing of surgery HCPCS/CPT codes which are exempted from multiple surgery discount logic.
RF796 OPFS bundled revenue codes Provides a listing of revenue codes which are bundled under qualified surgery or emergency room services on outpatient claims and encounters.
RF797 OPFS bundled rate driver Provides a list of HCPCS/CPT codes which qualify for a surgery or emergency room services bundling situation on outpatient claims and encounters.

Top of Page


AHCCCS Specific OPFS CCI Relationships

FROM CODE THRU CODE FORM MOD IND POL BEGIN DATE END DATE
99281 90776 B 0 P 2/1/2008 99/99/9999
99281 90779 B 0 P 2/1/2008 99/99/9999
99281 90772 B 0 P 5/1/2008 99/99/9999
99281 90773 B 0 P 5/1/2008 99/99/9999
99281 90774 B 0 P 5/1/2008 99/99/9999
99281 90775 B 0 P 5/1/2008 99/99/9999
99282 90776 B 0 P 2/1/2008 99/99/9999
99282 90779 B 0 P 2/1/2008 99/99/9999
99282 90772 B 0 P 5/1/2008 99/99/9999
99282 90773 B 0 P 5/1/2008 99/99/9999
99282 90774 B 0 P 5/1/2008 99/99/9999
99282 90775 B 0 P 5/1/2008 99/99/9999
99283 90776 B 0 P 2/1/2008 99/99/9999
99283 90779 B 0 P 2/1/2008 99/99/9999
99283 90772 B 0 P 5/1/2008 99/99/9999
99283 90773 B 0 P 5/1/2008 99/99/9999
99283 90774 B 0 P 5/1/2008 99/99/9999
99283 90775 B 0 P 5/1/2008 99/99/9999
99284 90776 B 0 P 2/1/2008 99/99/9999
99284 90779 B 0 P 2/1/2008 99/99/9999
99284 90772 B 0 P 5/1/2008 99/99/9999
99284 90773 B 0 P 5/1/2008 99/99/9999
99284 90774 B 0 P 5/1/2008 99/99/9999
99284 90775 B 0 P 5/1/2008 99/99/9999
99285 90776 B 0 P 2/1/2008 99/99/9999
99285 90779 B 0 P 2/1/2008 99/99/9999
99285 90772 B 0 P 5/1/2008 99/99/9999
99285 90773 B 0 P 5/1/2008 99/99/9999
99285 90774 B 0 P 5/1/2008 99/99/9999
99285 90775 B 0 P 5/1/2008 99/99/9999
G0378 90776 B 0 P 2/1/2008 99/99/9999
G0378 90779 B 0 P 2/1/2008 99/99/9999
G0378 90772 B 0 P 5/1/2008 99/99/9999
G0378 90773 B 0 P 5/1/2008 99/99/9999
G0378 90774 B 0 P 5/1/2008 99/99/9999
G0378 90775 B 0 P 5/1/2008 99/99/9999
G0379 90776 B 0 P 2/1/2008 99/99/9999
G0379 90779 B 0 P 2/1/2008 99/99/9999
G0379 90772 B 0 P 5/1/2008 99/99/9999
G0379 90773 B 0 P 5/1/2008 99/99/9999
G0379 90774 B 0 P 5/1/2008 99/99/9999
G0379 90775 B 0 P 5/1/2008 99/99/9999
G0380 90776 B 0 P 2/1/2008 99/99/9999
G0380 90779 B 0 P 2/1/2008 99/99/9999
G0380 90772 B 0 P 5/1/2008 99/99/9999
G0380 90773 B 0 P 5/1/2008 99/99/9999
G0380 90774 B 0 P 5/1/2008 99/99/9999
G0380 90775 B 0 P 5/1/2008 99/99/9999
G0381 90776 B 0 P 2/1/2008 99/99/9999
G0381 90779 B 0 P 2/1/2008 99/99/9999
G0381 90772 B 0 P 5/1/2008 99/99/9999
G0381 90773 B 0 P 5/1/2008 99/99/9999
G0381 90774 B 0 P 5/1/2008 99/99/9999
G0381 90775 B 0 P 5/1/2008 99/99/9999
G0382 90776 B 0 P 2/1/2008 99/99/9999
G0382 90779 B 0 P 2/1/2008 99/99/9999
G0382 90772 B 0 P 5/1/2008 99/99/9999
G0382 90773 B 0 P 5/1/2008 99/99/9999
G0382 90774 B 0 P 5/1/2008 99/99/9999
G0382 90775 B 0 P 5/1/2008 99/99/9999
G0383 90776 B 0 P 2/1/2008 99/99/9999
G0383 90779 B 0 P 2/1/2008 99/99/9999
G0383 90772 B 0 P 5/1/2008 99/99/9999
G0383 90773 B 0 P 5/1/2008 99/99/9999
G0383 90774 B 0 P 5/1/2008 99/99/9999
G0383 90775 B 0 P 5/1/2008 99/99/9999
G0384 90776 B 0 P 2/1/2008 99/99/9999
G0384 90779 B 0 P 2/1/2008 99/99/9999
G0384 90772 B 0 P 5/1/2008 99/99/9999
G0384 90773 B 0 P 5/1/2008 99/99/9999
G0384 90774 B 0 P 5/1/2008 99/99/9999
G0384 90775 B 0 P 5/1/2008 99/99/9999

Top of Page