Common Questions From AHCCCS Plans, Providers, Contractors & Vendors
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 65% of the covered billed charges.
For ground ambulance services, the rate is 80% of the covered billed charges.
