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: Fee schedules are updated annually on October 1st of each year. Additions are made quarterly to accommodate new codes.

Physician drug fee schedule is reviewed quarterly for significant price changes.

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: For AHCCCS FFS claims, where reimbursement is BR or "By Report", the AHCCCS FFS rate is 58.66% of the reasonable, usual, and customary covered billed charges. A charge is considered reasonable, usual and customary if it matches the general prevailing cost of that service within your geographic area.

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.