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Specialty Rates for Nursing Facility (NF) and Assisted Living Facility
Fee-For-Service (FFS) specialty rates for Nursing (NF) and Assisted Living Facilites (ALF) have been implemented for the 2020-20201 contract year. The AHCCCS Division of Fee for Service Management (DFSM) is currently working to apply these rates to existing specialty rate claims.
Please note - providers must submit documention for the purpose of verifying pricing of the respective specialty rates, prior to submitting the claim. This does not apply to NF and ALF claims that are not build for a FFS specialty rate.
As a reminder - the curent AHCCCS prior authorization flexibility is still in place for Nursing Facilities and Assisted Living Facilities and the above reference documenation requirement is only needed or the purpose of pricing specialty rate claims during DFSM's prior authorizaiton flexility timeframe.
Fee-For-Service (FFS) Rates & Codes
Q1: How often, and when, do you update your fee schedule each year?
A: Fee schedules are updated annually on October 1st of each year. Additions are made quarterly to accommodate new codes.
Physician drug fee schedule is reviewed quarterly for significant price changes.
Q2: Are the 51X (clinic) range of revenue codes covered under the OPFS?
A: Yes. 51X (clinic) revenue codes are covered under OPFS for all Providers (both Indian Health Service (HIS) and non-IHS) This coverage has been in effect since 5/1/2004 when the Physicians Fee Schedule structure was changed to include place-of-service based rates where applicable, consistent with Medicare rate structures (i.e. fees for applicable professional services differ for facility vs. non-facility). The aforementioned change eliminates the concerns associated with duplication of payments to the facility and practitioner for facility based services.
Q3: What does By Report (BR) indicate on the fee schedule?
A: For all AHCCCS FFS fee schedules, BR is 58.66% of the covered billed charges.
AHCCCS FFS Rates Contact Information
Have a question about AHCCCS Fee-for-Service reimbursement rates? Email us at FFSRates@azahcccs.gov.