Inpatient Hospital Tiered Per Diem Rates

Effective with dates of discharge on and after October 1, 2014, AHCCCS reimburses inpatient hospital services using the APR-DRG payment methodology.

Read more about the AHCCCS Transition to DRG-based Payment. The information on this page pertains to the tiered per diem payment methodology that was in effect for dates of admission on or before September 30, 2014.

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, 2013
• Rates Effective October 1, 2012
• Rates Effective October 1, 2011
• Rates PlansProviders April 1, 2011
• Rates Effective October 1, 2010
• Rates Effective October 1, 2009
• Excluded Surgical Procedures
• Maternity/Psychiatric Diagnosis Codes

Inpatient Hospital Cost-to-Charge Ratios

Per Arizona Administrative Code, R9-22-712.01, for qualification and payment of outlier claims with begin dates of service on or after October 1, 2011 through September 30, 2012, AHCCCS will reduce the cost-to-charge ratio determined under subsection for a hospital that filed a charge master with ADHS on or after April 1, 2011 by an additional percentage equal to the total percent increase reported on the charge master. In addition, for qualification and payment of outlier claims with begin dates of service on or after October 1, 2012, AHCCCS will reduce the cost-to-charge ratio for a hospital that filed a charge master with ADHS on or after June 1 of the prior federal fiscal year, by an additional percentage equal to the total percent increase reported on the charge master. Payors should refer to individual hospital rate sheets for specific hospital CCRs.

The statewide urban and rural inpatient cost-to-charge ratios for payment of outlier are:

• 10/01/2013 - 9/30/2014 - urban : .2238 rural : .3123
• 10/01/2012 - 9/30/2013 - urban : .2112 rural: .2590
• 10/01/2011 - 9/30/2012 - urban : .2455 rural : .3132
• 04/01/2011 - 9/30/2011 - urban : .2765 rural : .3582
• 10/01/2010 - 3/31/2011 - urban : .2910 rural : .3770
• 10/01/2009 - 9/30/2010 - urban : .3020 rural : .4060

Payments for out-of-state hospitals will be calculated using the urban cost-to-charge ratio times covered charges. The inpatient cost-to-charge ratios for out-of-state hospitals are:

• 10/01/2013 - 9/30/2014 : .2238
• 10/01/2012 - 9/30/2013 : .2112
• 10/01/2011 - 9/30/2012 : .2455
• 04/01/2011 - 9/30/2011 : .2765
• 10/01/2010 - 3/31/2011 : .2910
• 10/01/2009 - 9/30/2010 : .3020

For new hospitals that became AHCCCS eligible between 10-01-2009 and 9/30/2014, the statewide inpatient cost-to-charge ratios are:

• 10/01/2013 - 9/30/2014 - urban : .2238 rural : .3123
• 10/01/2012 - 9/30/2013 - urban : .2112 rural : .2590
• 10/01/2011 - 9/30/2012 - urban : .2455 rural : .3132
• 04/01/2011 - 9/30/2011 - urban : .2765 rural : .3582
• 10/01/2010 - 3/31/2011 - urban : .2910 rural : .3770
• 10/01/2009 - 9/30/2010 - urban : .3020 rural : .4060

Reimbursement and General Fee Schedule FAQs

Contacts

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