Hospital FFS Rates & Codes

The appearance on this website of a code and rate is not an indication of coverage, nor a guarantee of payment. AHCCCS covered procedures can be viewed in the AHCCCS Medical Policy Manual (AMPM). AHCCCS covered services can differ based upon enrollment.

Inpatient Hospital FFS Rates & Codes

• Rates Effective October 1, 2009 [PDF, 16KB]
• Rates Effective October 1, 2008 [PDF, 12KB ]
• Rates Effective October 1, 2007 [PDF, 12KB]
• Rates Effective October 1, 2006 [PDF, 31KB]
• Rates Effective October 1, 2005 [PDF, 31KB]
• Excluded Surgical Procedures [PDF, 23KB]
• Maternity/Psychiatric Diagnosis Codes [PDF, 19KB]

Inpatient Hospital Cost-to-Charge Ratios

Pursuant to R9-22-712.01 Section 2, subsection c., "For dates of service prior to October 1, 2007, the statewide inpatient hospital cost-to-charge ratio is used for payment of outliers, as described in subsections (4), (5), and (6), and out-of-state hospitals, as described in R9-22-712(B)." The Inpatient cost-to-charge ratio for payment outlier is .4075.

Pursuant to R9-22-712.01 Section 6, subsection c, "AHCCCS shall phase in the use of the Medicare Urban or Rural Cost-to-Charge Ratios for outlier determination, threshold calculation, and outlier payment calculation. The three year phase-in does not apply to out of state or new hospitals." The phase-in will be complete as of October 1, 2009, and the CCRs will align with CMS Urban and Rural percentages for Arizona. The urban and rural inpatient cost-to-charge ratios for payment of outlier are:

• 10/01/2009 - 9/30/2010 - urban: .3020, rural: .4060
• 10/01/2008 - 9/30/2009 - urban: .3405, rural: .4145
• 10/01/2007 - 9/30/2008 - urban: .3737, rural: .4143

Pursuant to R9-22-712.01 Section 11, "Outliers for out-of-state hospitals will be calculated using the Medicare urban cost-to-charge ratio times covered charges. If the resulting cost is equal to or above the urban outlier threshold, the claim will be paid at the Medicare Urban Cost-to-Charge Ratio times covered charges." The inpatient cost-to-charge ratios for out-of-state hospitals are:

• 10/01/2009 - 9/30/2010: .3020
• 10/01/2008 - 9/30/2009: .3070
• 10/01/2007 - 9/30/2008: .3060

Pursuant to R9-22-712.01 Section 11, "Outliers for new hospitals will be calculated using the Medicare Urban or Rural Cost-to-Charge Ratio times covered charges. If the resulting cost is equal to or above the cost threshold, the claim will be paid at the Medicare Urban or Rural Cost-to-charge ratio." For new hospitals that became AHCCCS eligible between 10-01-2007 and 9/30/2010, the inpatient cost-to-charge ratios are:

• 10/01/2009 - 9/30/2010 - urban: .3020, rural: .4060
• 10/01/2008 - 9/30/2009 - urban: .3070, rural: .4180
• 10/01/2007 - 9/30/2008 - urban: .3060, rural: .4280

Outpatient Hospital FFS Rates & Codes

The Outpatient Hospital Fee Schedule is updated annually October 1; new codes are incorporated annually January 1.

• Rates Effective October 1, 2009 (Updated with new codes July 1, 2010) [Excel, 2MB]
• Rates Effective October 1, 2008 [Excel, 1.91MB]
• Rates Effective October 1, 2007 [Zip (PDF, Excel), 342KB]
• Rates Effective October 1, 2006 [Zip (PDF, Excel), 421KB]

Outpatient Hospital Cost-to-Charge Ratio

Pursuant to ARS 36-2903.01(H)(3) as amended by the Laws of 2004 Chapter 279, any covered outpatient hospital service with dates of service on or after July 1, 2005 that does not have a rate listed on the outpatient hospital capped fee-for-service schedule shall be reimbursed by applying the statewide cost-to-charge ratio of .3192.

Outpatient Hospital Fee Schedule Rate Rebase Information

Outpatient Hospital Fee Schedule Technical Information & FAQs

Contacts

Have a question about AHCCCS Fee-for-Service reimbursement rates? Email us at FFSRates@azahcccs.gov.