Frequently Asked Questions

General Questions

• Q1: When will AHCCCS begin reimbursing for traditional healing?

  A: AHCCCS will start reimbursing traditional healing services on October 1, 2025.

• Q2: Who can provide AHCCCS reimbursable traditional healing services?

  A: Traditional healing services must be provided by healers who are employed by or contracted with an Indian Health Service (IHS)/638 facility. Healers affiliated with an Urban Indian Organization (UIO) may also provide services through a Care Coordination Agreement (CCA) with an IHS/638 facility.

• Q3: Who can receive traditional healing services?

  A: AHCCCS members who qualify for services at an IHS/638 facility are eligible. Members enrolled in AHCCCS Complete Care (ACC) plans may receive traditional healing services, except for those enrolled in the Federal Emergency Services Program (FESP), who are not eligible.

• Q4: What traditional healing services will be eligible for reimbursement?

  A: Each IHS/638 facility will work with its local Tribal community to decide which services are appropriate for Medicaid reimbursement. These may include ceremonial consultations, traditional counseling, sweat lodge services, and other culturally significant healing practices.

• Q5: Do I need to be on the American Indian Health Plan (AIHP) to receive traditional healing services?

  A: No. Eligible members in any AHCCCS health plan may receive traditional healing services. Reimbursement depends on the member’s health plan at the time the service is provided.

• Q6: Where can I send questions I have regarding AHCCCS traditional healing services?

  A: You can email your questions to TribalRelations@AHCCCS.gov.

• Q7: What is the difference between the All Inclusive Rate and the Fee-for-Service Rate

  A: The AIR is a flat rate used by IHS/638 facilities that covers all approved services during one visit. The FFS rate pays for individual services and follows the rules in the AHCCCS Fee-For-Service Manual.

• Q8: Are there any limits on how many traditional healing services a member can receive?

  A: No. There are no limits as long as the services are medically necessary and recommended by an AHCCCS registered provider.

• Q9: Can claims for traditional healing services be sent directly to AHCCCS for members with Medicare as the primary payer, without first getting a denial?

  A: Yes, Since Medicare does not cover traditional healing services, IHS/638 facilities do not need to submit claims to Medicare first when using revenue code 0509.

• Q10: Can traditional healing services be billed for each AHCCCS member in a group session?

  A: Yes. A claim may be submitted for each eligible member who received services in a group setting, as long as they were enrolled on the date of service.

• Q11: Is it appropriate to use a group modifier with HCPCS (Healthcare Common Procedure Coding System) H0051?

  A: AHCCCS is currently reviewing this. More guidance will be provided about using a group billing modifier with code H0051.

• Q12: What revenue code should be used for billing traditional healing services?

  A: Use revenue code 0509 to identify traditional healing services provided to American Indian/Alaska Native (AI/AN) members.

• Q13: Are traditional healers required to use the SOAP (Subjective, Objective, Assessment, Plan) note format?

  A: No. Documentation must show that the service was medically necessary, but it does not have to follow the SOAP format.

• Q14: Does the provider who refers a member for traditional healing services have to be a primary care provider?

  A: No. Any AHCCCS registered provider working within their licensed scope of practice may refer a member for traditional healing services.

• Q15: How do I submit a KidsCare claim for traditional healing services provided to AIHP members?

  A: If a member is enrolled in FFS or AIHP, submit the claim directly to AHCCCS using the CMS 1500 or 837P form with HCPCS code H0051. Only one unit per day is allowed, and services are paid at the FFS rate. If an MCO member, the ACC plan is billed directly

• Q16: Do traditional healers need an AHCCCS provider identification number to offer reimbursable services?

  A: No. Traditional healers do not need to register individually with AHCCCS. Claims must use the National Provider Identifier (NPI) of the IHS/638 facility or clinic.

• Q17: Are traditional healing services provided through telehealth eligible for reimbursement?

  A: No. AHCCCS does not reimburse traditional healing services delivered via telehealth.

• Q18: How does a facility show that its traditional healing providers are qualified to provide reimbursable services?

  A: Facilities must establish a process to:

  • Identify individuals recognized and qualified to provide traditional healing;
  • Verify that the healer possesses the appropriate knowledge, training, or community recognition;
  • Ensure services billed to Medicaid are only provided by these qualified individuals.
• Q19: What is the correct process to submit claims for AHCCCS members with Third Party Liability (TPL) coverage?

  A: If a member has other insurance (excluding Medicare or Tribal Self Insurance), the claim must be sent to the primary insurance payer first. The provider will need to include the Explanation of Benefits (EOB) when submitting the claim to AHCCCS as the secondary payer.