MedicaidCoverageMedium impact
AHCCCS DFSM Claims Clues - October 2017
Arizona Medicaid - AHCCCS·AZ · Dentistry·Claims & Billing
Effective date
Oct 1, 2017
We identified it
Jun 17, 2026
Summary
Effective October 1, 2017, AHCCCS Fee-For-Service members 21+ receive new $1,000 annual dental benefit for emergency care and extractions only (not routine care). ALTCS members now get two separate $1,000 dental benefits - one for routine care and one for emergency care.
Action Required
Immediately: Update billing system to recognize new $1,000 emergency dental benefit for AHCCCS FFS members 21+ and dual $1,000 benefits for ALTCS members. Train staff that modifier 59 cannot be used with E&M codes (99201-99499) or radiation therapy codes (77261-77499) and will trigger medical review. Implement face-to-face encounter requirements for home health services (within 90 days prior or 30 days after start) and medical equipment orders (within 60 days prior). Claims with incorrect modifier 59 usage will be denied.