Common Questions From AHCCCS Plans, Providers, Contractors & Vendors


Fee-For-Service (FFS) Rates & Codes

Q: How often, and when, do you update your fee schedule each year?

A: Physician fees schedules are updated annually, on or near April 1st of each year. Quarterly adjustments July 1, October 1, and January 1 may be made to accommodate new codes or rate adjustments.

Behavioral health fees are adjusted July 1st.

Hospital rates are adjusted October 1st; however, this year we moved to a fee schedule for outpatient rates July 1, 2005. The next adjustment will be October 1, 2006.

Long-term care rates - nursing facilities, home & community based services, and hospice - are updated annually October 1st.

Other rates, such as transportation, are based on analysis and updated when needed. We post a "NEW" flag on these rates and date them on our web site when they have been updated.

Q: 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.

Q: What does By Report (BR) indicate on the fee schedule?

A: On the Physician Fee Schedules, BR is 58.66% of the covered billed charges. For ground ambulance services, the rate is 68.59% of the covered billed charges.

Q: Where or how can I report concerns about the quality of care an AHCCCS member (self or other) is receiving

A: Please view the Reporting Quality of Care Concerns Presentation to review the agencies where concerns can be reported and how to report the issue. A desk aid is available to print that lists the contact information for different agencies depending on the type of issue.The quality of health care provided to all AHCCCS members is important to us.