You are invited to participate in a survey regarding your experience using the AHCCCS
website. This survey will take approximately two minutes. Your responses will help
us ensure that you have a high quality experience.
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 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:
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
For new hospitals that became AHCCCS eligible between 10-01-2009 and 9/30/2014,
the statewide inpatient cost-to-charge ratios are:
Reimbursement and General Fee Schedule FAQs
Have a question about AHCCCS Fee-for-Service reimbursement rates? Email us at FFSRates@azahcccs.gov.
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