← Back to list
AHCCCS DFSM Claims Clues - September 2016
Effective date
Oct 1, 2016
Identified
Jun 17, 2026
Summary
Effective for dates of discharge on and after 10/01/2016, LARC devices are permitted to be separately reimbursed outside the APR-DRG payment when billed by the hospital on a CMS 1500 claim with the appropriate HCPCS code. Effective service dates on and after October 1, 2016, AHCCCS covers medically necessary podiatry services for adults age 21 and older when provided by a licensed podiatrist and ordered by the recipient's primary care provider, attending physician or primary care practitioner. Restoration of the ALTCS dental benefit has an effective date of date of service 10/01/2016.
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 · 13 steps
01Already effective 2016-10-01: Billing team: for LARC devices, the hospital bills the device on a CMS 1500 claim with the appropriate HCPCS procedure code, which is reimbursed at the AHCCCS fee schedule rate for that code.
02This does not apply to individuals on the Federal Emergency Services Program (FESP).
03Review the FFS Provider Billing Manual, Chapter 11 Addendum (APR-DRG).
04Podiatry: bill podiatry services for adults age 21 and older only when a licensed podiatrist provides them and the recipient's primary care provider, attending physician or primary care practitioner orders them.
05Billing requirements were to be included in the FFS and IHS/Tribal Provider Billing Manual chapter updates.
06ALTCS dental: for ALTCS members age 21 and older at risk for institutional level of care, the dental benefit limit is up to $1,000.00 per contract year (10/1 through 9/30).
07Benefit coverage is member-specific and remains with the member when transferring between MCOs or between FFS and managed care, and unused benefits do not roll over.
08Reimbursement is subject to the Dental FFS Rates and Codes.
09Behavior Analysts (BCBA): providers cannot submit claims for BCBA services with date of service October 1, 2016 unless an active AHCCCS-registered BCBA provider is submitted as the rendering/service provider.
10Licensed BCBAs needed to submit a provider registration packet Previously due August 15, 2016 (date passed; verify current applicability), a deadline that has passed, so check current registration status.
11NEMT referrals beyond the nearest facility: the referring facility or provider faxes the medical necessity documentation, using the Prior Authorization Medical Documentation Form as a cover sheet, to the Transportation fax number 602-254-2431, not to the transportation provider.
12Dental deep sedation/general anesthesia: claims are submitted electronically to the FFS Claims area with the dentist's substantiation of necessity, treatment plan and schedule, and radiographic images.
13Claims found reimbursed incorrectly are subject to recoupment.
Codes mentioned
J7297J7298J7300J7301J7307
Original notice
AHCCCS DFSM Claims Clues - September 2016
azahcccs.gov · Always check the source before changing claims.
Related changes
See all Arizona Medicaid - AHCCCS changes →AHCCCS DFSM Claims Clues - March 2020MediumEffective 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