Effective May 1, 2023, AHCCCS has set a rate for fee-for-service providers who provide behavioral health services and bill AHCCCS for intensive outpatient program treatment. This change established a set rate of $157.86 for one unit of billable service, a change from the prior rate methodology which paid 58.66% of the billed amount.
AHCCCS established this fixed rate for billing code H0015 after a thorough data analysis of rates paid for these services by other Medicaid programs and AHCCCS managed care organizations, as well as the current AHCCCS reimbursement for comparable services. While the new rate may be lower than what was billed by some providers under the prior methodology, it is approximately $25 higher than industry average.
The H0015 billing code is meant for intensive outpatient treatment services for substance use disorder based on an individualized treatment plan, and is only allowed to be billed once per day.
Approximately 94% of AHCCCS members are enrolled in managed care health plans, which have the ability to set their own rates for intensive outpatient treatment services and are not directly affected by this change. More than 2,200 behavioral health providers in Arizona serve members across the spectrum of mental health and substance use needs; approximately 200 providers may be affected by this rate change.