AHCCCS Fee-for-Service Rates
Home and Community Based Services

HCBS Rates Effective October 1, 2008 through September 30, 2009
HCPCS Code Description  Provider
Type		 AHCCCS 10/01/08 Rate
S5100 Day Care Services, Adult; per 15 min. 27, 81 $2.55
S5101 Day Care Services, Adult; per half day 27, 81 $31.30
S5102 Day Care Services, Adult; per diem 27, 81 $62.60
S5125 Attendant Care Services; 15 min. 2, 23, 24, 40, 81, 95 $4.50
S5130 Homemaker Services, NOS; 15 min. 23, 24, 37, 39, 40, 81, 95 $5.85
S5150 Unskilled Respite Care, not hospice; per 15 min. 2, 23, 24, 37, 39, 40, 72, 77, 81, A3 $4.60
S5151 Unskilled Respite Care, not hospice; per diem 2, 23, 24, 36, 37, 39, 40, 49, 50, 72, 77, 81, A3 $234.70
S5170 Home Delivered Meals 70, 81 $9.10
G0154 Services of a skilled nurse in a home health setting, each 15 minutes (for visits of two hours or less in duration up to a total of four hours per day) 2, 23 $26.30
46 $20.05
39, 81, 95 $23.05
2, 23 $26.30
S9123 Nursing Care in the Home; RN, per hour (for general nursing care only, do not use when CPT codes 99500-99602 can be used) 2, 23 $68.85
46 $36.85
39, 81, 95 $57.35
S9124 Nursing Care in the Home; LPN, per hour 2, 23 $52.65
46 $28.70
39, 81, 95 $44.65
T1019 Personal Care Services, per 15 min., not for an inpatient or resident of a hospital, NF, ICF/MR, or IMD (not to be used to identify services provided by home health aide or CAN) 2, 23, 24, 39, 40, 72, 77, 81, 95 $6.15
T1021 Home Health Aide or Certified Nurse Assistant, per visit 2, 23 $38.60
 
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Effective October 1, 2007 through September 30, 2008
NOTE:  Effective with dates of service on or after 10/01/2007 coding for Home Health Nursing visits has changed. For visits of less than two hours in duration or multiple visits of less than fours per day, use code G0154. For nursing visits of more than two hours in duration or multiple visits totaling more than four hours in one day use HCPCS codes S9123 or S9124. Use of the TG modifier is discontinued as of 10/01/2007.
HCPCS Code Description Provider Type AHCCCS 10/01/07 Rate
S5100 Day Care Services, Adult; per 15 min. 27, 81 $2.45
S5101 Day Care Services, Adult; per half day 27, 81 $30.00
S5102 Day Care Services, Adult; per diem 27, 81 $60.00
S5125 Attendant Care Services; 15 min. 2, 23, 24, 40, 81, 95 $4.30
S5130 Homemaker Services, NOS; 15 min. 23, 24, 37, 39, 40, 81, 95 $5.60
S5150 Unskilled Respite Care, not hospice; per 15 min. 2, 23, 24, 37, 39, 40, 72, 77, 81, A3 $4.40
S5151 Unskilled Respite Care, not hospice; per diem 2, 23, 24, 36, 37, 39, 40, 49, 50, 72, 77, 81, A3 $225.00
S5170 Home Delivered Meals 70, 81 $8.70
G0154 Services of a skilled nurse in a home health setting, each 15 minutes (for visits of two hours or less in duration up to a total of four hours per day) 2, 23 $25.20
46 $19.20
39, 81, 95 $22.10
2, 23 $25.20
S9123 Nursing Care in the Home; RN, per hour (for general nursing care only, do not use when CPT codes 99500-99602 can be used) 2, 23 $66.00
46 $35.35
39, 81, 95 $55.00
S9124 Nursing Care in the Home; LPN, per hour 2, 23 $50.50
46 $27.50
39, 81, 95 $42.80
T1019 Personal Care Services, per 15 min., not for an inpatient or resident of a hospital, NF, ICF/MR, or IMD (not to be used to identify services provided by home health aide or CAN) 2, 23, 24, 39, 40, 72, 77, 81, 95 $5.90
T1021 Home Health Aide or Certified Nurse Assistant, per visit 2, 23 $37.00
 
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Effective October 1, 2006 through September 30, 2007
HCPCS Code Description Provider Type AHCCCS 10/01/06 Rate
S5100 Day Care Services, Adult; per 15 min. 27, 81 $2.11
S5101 Day Care Services, Adult; per half day 27, 81 $25.41
S5102 Day Care Services, Adult; per diem 27, 81 $50.81
S5125 Attendant Care Services; 15 min. 2, 23, 24, 40, 81, 95 $4.06
S5130 Homemaker Services, NOS; 15 min. 23, 24, 37, 39, 40, 81, 95 $5.30
S5150 Unskilled Respite Care, not hospice; per 15 min. 2, 23, 24, 37, 39, 40, 72, 77, 81, A3 $4.18
S5151 Unskilled Respite Care, not hospice; per diem 2, 23, 24, 36, 37, 39, 40, 49, 50, 72, 77, 81, A3 $214.43
S5170 Home Delivered Meals 70, 81 $8.29
S9123 Nursing Care in the Home; RN, per hour (for general nursing care only, do not use when CPT codes 99500-99602 can be used)(Intermittent) 2, 23 $85.62
S9123-TG Nursing Care in the Home; RN, per hour (Continuous) 2, 23 $63.15
S9123 Nursing Care in the Home; RN, per hour (Intermittent) 46 $49.35
S9123-TG Nursing Care in the Home; RN, per hour (Continuous) 46 $33.58
S9123 Nursing Care in the Home; RN, per hour (Intermittent) 39, 81, 95 $71.48
S9123-TG Nursing Care in the Home; RN, per hour (Continuous) 39, 81, 95 $52.70
S9124 Nursing Care in the Home; LPN, per hour (Intermittent) 2, 23 $65.33
S9124-TG Nursing Care in the Home; LPN, per hour (Continuous) 2, 23 $48.17
S9124-TG Nursing Care in the Home; LPN, per hour (Continuous) 46 $26.37
S9124 Nursing Care in the Home; LPN, per hour (Intermittent) 39, 81, 95 $55.32
S9124-TG Nursing Care in the Home; LPN, per hour (Continuous) 39, 81, 95 $40.79
T1019 Personal Care Services, per 15 min., not for an inpatient or resident of a hospital, NF, ICF/MR, or IMD (not to be used to identify services provided by home health aide or CAN) 2, 23, 24, 39, 40, 72, 77, 81, 95 $5.59
T1021 Home Health Aide or Certified Nurse Assistant, per visit 2, 23 $35.37

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