AHCCCS Medical Policy Manual (AMPM)

The AHCCCS Medical Policy Manual (AMPM) provides information to Contractors and Providers regarding services that are covered within the AHCCCS program. The AMPM is applicable to both Managed Care and Fee-for-Service members.

The AMPM should be referenced in conjunction with State and Federal regulations, other Agency manuals [AHCCCS Contractors' Operations Manual (ACOM) and the AHCCCS Fee-for-Service Manual], and applicable contracts.

Note: Information provided in PDF files.

"What's New" Memo

Revisions to the AMPM are completed on a periodic basis. The What's New memo describes the changes or additions being made.

What's New November 2009 [25KB]

Updated versions of each chapter of the AMPM may be obtained below.

Download Entire Manual [Zip]

Medical Policy Manual [12.1MB]

Download Individual Chapters [PDF]

Manual Table of Contents [80KB]
Chapter 100: Introduction [353KB]
Chapter 200: Reserved
Chapter 300: Medical Policy for Covered Services [2MB]
Chapter 400: Medical Policy for Maternal and Child Health [1.3MB]
Chapter 500: Care Coordination Requirements [538KB]
Chapter 600: Provider Qualifications and Requirements [279KB]
Chapter 700: School Based Claiming Program/Direct Services Claiming [231KB]
Chapter 800: Fee-For-Service Quality and Utilization Management [584KB]
Chapter 900: Quality Management and Performance Improvement Program [1MB]
Chapter 1000: Utilization Management Program [511KB]
Chapter 1100: Federal Emergency Services (FES) Program [204KB]
Chapter 1200: ALTCS Services and Settings for Members Who Are Elderly and/or Have Physical Disabilities and/or Have Developmental Disabilities [1.5MB]
Chapter 1300: Self Directed Attendant Care (SDAC) Option [287KB]
Chapter 1400: Reserved
Chapter 1500: Reserved
Chapter 1600: Case Management [1.51MB]
Appendices
- Appendices Table of Contents [16KB]
- Appendix A, EPSDT and Adult Quarterly Monitoring [275KB]
- Appendix B, EPSDT Tracking Forms [1.5MB]
- Appendix C, Reserved
- Appendix D, Medical Foods Flow [48KB]
- Appendix E, Childhood and Adolescent Behavioral Health Tool Kits
  - Child ADHD [583KB]
  - Child Anxiety [743KB]
  - Child Depression [692KB]
- Appendix F, Adult Behavioral Health Tool Kits
  - Adult ADHD [753KB]
  - Adult Anxiety [735KB]
  - Adult Depression [733KB]
  - Postnatal Depression [553KB]
- Appendix G, Reserved
- Appendix H, Reserved
- Appendix I, Charts for Estimating Body Mass Index [330KB]
- Appendix J, FFS Mileage Reimbursement Form [36KB]

Revision History
What's New	Chapters Affected
October 2009 - second release	Policy 320-A: Affiliated Practice Dental Hygienist Policy; Policy 430: EPSDT Services; Policy 720-C: Nursing and Personal Care Services
October 2009 - first release	Chapter 100: Entire Chapter Reviewed and Modified; Chapter 300 - Policy Changes Related to Benefit Redesign: Policy 310-N - Laboratory, Policy 310-T - Physician Services, Policy 310-Z - Sleep Studies (Polysomnography), Policy 310-EE - Negative Pressure Wound Therapy; Chapter 300 - Other Changes: Policy 310-D - Dental Services or Members 21 Years of Age and Older, Policy 310-V - Prescription Medication/Pharmacy Services, Policy 310-DD - Covered Transplants and Related Immunosuppressant Medication, Policy 320-L - Neuropsychological Testing; Chapter 400: Entire Chapter Reviewed and Modified; Chapter 900: Entire Chapter Reviewed and Modified; Chapter 1200: Policy 1210 - Institutional Services and Settings; Appendix A: EPSDT Improvement and Adult Quarterly Monitoring Report Instructions and Template; Appendix B: AHCCCS EPSDT Tracking Forms
September 2009	Chapter 300-Policy 310-S: Observation Services; Chapter 800-Policy 820-P: Observation Services that Exceed 24 Hours; Chapter 1600-Exhibit 1620-10
June 2009	Chapter 300-Policy 320-K: Tobacco Cessation Product Policy; Chapter 1200-Policy 1200-Overview
April 2009	Appendix E-Childhood and Adolescent Behavioral Health Tool Kits; Appendix F-Adult Behavioral Health Tool Kits; Chapter 300-Policy 310B-Behavioral Health Services; Chapter 400-Policy 430-EPSDT
February 2009	Chapter 300-Policy 310DD & Policy 320-B; Chapter 800-Policy 810; Chapter 1100, Appendix G-Behavioral Health Services Guide
January 2009	Chapter 400-Policy 430 & Exhibit 430-2; Chapter 1200-Policy 1240-M; Chapter 1600-Policy 1620 & Policy 1630

NOTE: Contact AHCCCS for prior revision information.

General Questions or Changes to the Manual

For questions regarding the AMPM, including the following items, please contact the Office of Medical Policy (OMP) at 602-417-4627:

General Updates (this month and past months)
Obtaining Older Policy
Medical Policy-related Questions

For technical assistance, please call OMP Technical Support 602-417-4053.