AHCCCS Fee-For-Service 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.

• Ambulatory Surgical Center (ASC)
• Behavioral Health
• Dental
• Dialysis
• Hemophilia Factor
• Home & Community Based Services (HCBS)
• Hospice
• Hospitals
  • Outpatient Fee Schedule Technical Information
• Nursing Facility
• Pharmacy Vaccine Administration and 340B Dispensing Fee
• Physician Fee Schedules
• Transplant
• Transportation

AHCCCS Rate Rebases

• Pursuant to Arizona Administrative Code, R9-22-712.40, AHCCCS will begin the rebase of the Outpatient Fee Schedule (OPFS) in November of 2009.
  • Outpatient Hospital Fee Schedule Rate Rebase Information
• Pursuant to Arizona Revised Statute Section 36-2959, AHCCCS will begin the rebase of the Nursing Facility Fee Schedule and the Home and Community Based Services (HCBS) Fee Schedule in November of 2009.
  • Nursing Facility and HCBS Rate Rebase Information

Reimbursement and General Fee Schedule FAQs

Provider Rate Reductions

AHCCCS October 1, 2011 Provider Rate Reductions

Laws 2011, Chapter 31, gives AHCCCS authority to reduce rates for all providers up to 5%. Effective October 1, 2011, AHCCCS will reduce by 5%:

All Provider Rates, Except for:

• Drugs administered in a physician's office
• Hospice rates - AHCCCS matches Medicare rates as required by Federal law.
• Payments for services provided by the Indian Health Service or Tribal 638 facilities claimed at 100% FMAP.

All Payment Ratios:

• All payment ratios utilized for provider reimbursement will also be reduced by 5%. (e.g. all Cost-to-Charge Ratios (CCRs), By Report Percentages (BR), etc.)

Additional information, such as the Notice of Exempt Proposed Rulemaking and State Plan Amendment to CMS will be posted on the web as it becomes available.

AHCCCS April 1, 2011 Provider Rate Reductions
On April 1, 2011, AHCCCS will be reducing provider rates by the following percentages:

Reduced 5%:

• Inpatient hospital rates
• Cost to Charge ratios used to qualify and pay inpatient outliers
• Outpatient hospital rates
• Dental rates
• Physician fee schedule rates

– including DMEPOS and Clinical Lab
– including percentage for codes paid "By Report" (from 65.00% to 61.75%)
– excluding the Physician Drug Schedule
• Dialysis center composite rates
• ADHS Transportation rates
• Non-ADHS Transportation rates
• Behavioral Health rates (including AHCCCS inpatient psychiatric tiered per diem rates and bed holds) with the exception of:

– All other Acute Care Hospital/Level 1 Hospitalization
– All Level 1 Sub Acute Facilities
– All Level 1 Residential Treatment Centers

Reduced 2.5%:

• In-Home service rates, including Adult Day Health (excluding services paid by DDD)

No Rate Reduction:

• NF rates
• ASC rates
• Pharmacy
• Alternative Residential Facilities
• Hospice
• Exceptions noted above

More information is provided on the Provider Rate Reduction Fact Sheet .

AHCCCS Rate Comparisons and Access to Care Studies  

Milliman Reports

• Arizona Medicaid Access to Care Study, 2010
• Arizona Medicaid Access to Hospital Care – 2011 Update

AHCCCS Reports

• Access to Care Memo – 2009
• Access to Care Memo – 2010
• Access to Care Memo – 2011
• 2011 Fee Schedule Rate Comparison

Contacts

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