Summary
For discharges on and after 10/01/2016, LARC devices are separately reimbursed outside the APR-DRG payment when a hospital bills them on a CMS 1500 with the HCPCS codes J7297, J7298, J7300, J7301 or J7307, at the AHCCCS fee schedule rate for that code. For paper claims, ICD-10 diagnosis codes are required, claims with an ICD-9 diagnosis will be denied, and behavioral health services billed with a DSM-4 diagnosis code will be denied. BHRFs may not submit H0031 or H2019 in addition to the BHRF per diem code H0018. The AHCCCS Provider Enrollment Portal is expected to launch August 31, 2020.
Get alerts when payers change rules like this one
We check Arizona Medicaid - AHCCCS and other payers every day and email you when a change matches your specialty and state.
Get Arizona Medicaid - AHCCCS alertsPolicy Monitoring is free. No card required.
What to do
Action · 22 steps
01Already effective for discharges on and after 2016-10-01: Hospitals bill LARC devices on a CMS 1500 with the appropriate HCPCS code for separate reimbursement, outside the APR-DRG payment, at the AHCCCS fee schedule rate for that code.
02The codes are J7297 (levonorgestrel-releasing IUCS, 52 mg, 3 year duration), J7298 (levonorgestrel-releasing IUCS, 52 mg, 5 year duration), J7300 (intrauterine copper contraceptive), J7301 (levonorgestrel-releasing IUCS, 13.5 mg) and J7307 (etonogestrel implant system, including implant and supplies).
03This does not apply to individuals on the Federal Emergency Services Program (FESP).
04Refer to Chapter 11 Addendum (APR-DRG) of the FFS Provider Billing Manual.
05Paper claims (ADA 2012, CMS-1500, UB-04): Enter at least one ICD-10 diagnosis code.
06Claims with an ICD-9 diagnosis will be denied.
07Behavioral health providers must not use DSM-4 diagnosis codes.
08Enter the ICD indicator (0 for ICD-10-CM) in the ICD Ind.
09field of CMS-1500 field 21, or in the indicated area of UB-04 field 66.
10A blank ICD indicator returns the claim.
11Enter diagnoses in order, so that diagnosis B is not skipped before diagnosis C.
12The preferred font is Lucinda Console, size 10.
13Do not handwrite on any part of the claim form except the signature, and do not use highlighter or color marks, white out, correction tape, or labels and stamps (except a signature).
14Do not staple claims to documentation.
15Black and white copies of the CMS-1500 and UB-04 are returned.
16When faxing, send the claim form first, the EOB second and documentation third.
17Resubmissions do not need the word resubmission written on them, because the claims system uses the included CRN.
18Behavioral health residential facilities (provider type B8): H0031 and H2019 may not be submitted in addition to the BHRF per diem code H0018.
19Specialized services that the BHRF cannot perform are billed by the provider who performed them, and the service type and rendering provider name must be in the member's treatment or service plan.
20FESP: Only services that fully meet the federal definition of an emergency medical condition will be covered.
21Services that do not meet that definition are manually denied with informational code MD034, Emergency Criteria Not Met.
22Chapter 18 of the FFS Provider Billing Manual covers federal emergency services.
Codes mentioned
J7297J7298J7300J7301J7307H0031H2019H0018
Original notice
AHCCCS DFSM Claims Clues - March 2020
azahcccs.gov · Always check the source before changing claims.
Related changes
See all Arizona Medicaid - AHCCCS changes →AHCCCS DFSM Claims Clues - September 2016MediumEffective Oct 1, 2016 · Claims & BillingAHCCCS DFSM Claims Clues - July/August 2020MediumNo effective date · Claims & BillingAHCCCS DFSM Claims Clues - October 2020MediumNo effective date · Claims & BillingAHCCCS DFSM Claims Clues - November/December 2020MediumEffective Apr 1, 2021 · Claims & BillingBrowse every Arizona Medicaid - AHCCCS change in the policy list