Outpatient Hospital Fee Schedule Reference Extracts

  • RF723 - Modifiers which Override Specified Limitation (Extract)
    Provides a list of modifiers under Action Codes 02 and 04, which when billed with any applicable HCPCS/CPT on an outpatient hospital claim or encounter, require exception processing to override of service limits or CCI editing as defined by the action code. Please note - Modifiers on this table associated with Action Codes 07, 08 and 09 are not applicable to OPFS claims or encounter processing.  
  • RF739 - Surgery Bundling Exception Procedures (Extract)
    Provides a list of HCPCS/CPT codes under Action Code 05, which when billed with a normally bundled revenue code on an outpatient hospital claim or encounter, require exception processing to override bundling if the bundling trigger for the claim or encounter is Surgical.Please note - Procedures on this table associated with Action Codes 07, 08 and 09 are not applicable to OPFS claims or encounter processing.
  • RF773 - Revenue Codes to Procedure Codes (Extract)
    Provides a listing by HCPCS/CPT which revenue codes are applicable for OPFS reporting.
    • Download Tables - refreshed 01/08/14
      • RF773 A0000-Z9999 [PDF]
      • RF773 00001-99999 [PDF]
      • RF773 A0000-Z9999 [Excel]
      • RF773 00001-19999 [Excel]
      • RF773 20000-29999 [Excel]
      • RF773 30000-39999 [Excel]
      • RF773 40000-49999 [Excel]
      • RF773 50000-59999 [Excel]
      • RF773 60000-69999 [Excel]
      • RF773 70000-79999 [Excel]
      • RF773 80000-99999 [Excel]
  • RF774 - Revenue Codes to Bill Types (Extract)
    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.
    • Download Tables - refreshed 01/08/14
      • RF774 0001-0599 [PDF]
      • RF774 0600-3109 [PDF]
      • RF774 0001-0199 [Excel]
      • RF774 0200-0299 [Excel]
      • RF774 0300-0399 [Excel]
      • RF774 0400-0499 [Excel]
      • RF774 0500-0599 [Excel]
      • RF774 0600-0699 [Excel]
      • RF774 0700-0799 [Excel]
      • RF774 0800-0899 [Excel]
      • RF774 0900-3109 [Excel]
  • RF796 - Bundled Revenue Codes (Extract)
    Provides a listing of revenue codes which are bundled under qualified surgery or emergency room services on outpatient claims and encounters.
  • RF797 – ER and Surgery Bundling Trigger Procedures (Extract)
    Provides a list of HCPCS/CPT codes which trigger surgery or emergency room services bundling situations on outpatient claims and encounters.
  • RFC97 – Observation Bundling Trigger Procedures
    Provides a list of HCPCS/CPT codes which trigger observation bundling situations for outpatient claims and encounters not already bundled under ER or Surgery.
    • Current values for this table are procedure codes G0378 and G0379.
  • RF126 - Outpatient Fee Schedule
    Provides a list of AHCCCS FFS payment rates by HCPCS/CPT codes for outpatient claims and encounters.
  • RF133 – Outpatient Revenue Code 051X Fee Schedule
    Provides a list of AHCCCS FFS payment rates by HCPCS/CPT codes when reported in association with 051X clinic revenue codes for outpatient claims and encounters.
    • Refer to last worksheet of the Outpatient fee schedule.
  • RF724 - Extract of Procedures Subject to Multiple Procedure Reductions (Extract)
    Provides a list of HCPCS/CPT codes which are subject to multiple procedure pricing considerations.

Contact

You are invited to e-mail us at AHCCCSOutpatientHospitalFeeSchedule@azahcccs.gov to provide comments following review of newly published information, or with any questions.