MedicaidBilling CodesHigh impact
AHCCCS DFSM Claims Clues - February 2013
Arizona Medicaid - AHCCCS·AZ · Family Medicine, Internal Medicine, Pediatrics·Claims & Billing
Effective date
Jan 1, 2013
We identified it
Jun 17, 2026
Summary
AHCCCS requires rendering provider information to be accurately reported on all claims, with each individual who provided care listed correctly. New vaccine administration billing requirements mandate reporting both vaccine codes and administration codes separately, with enhanced administration fees retroactive to January 1, 2013.
Action Required
Immediately: Update billing procedures to ensure correct rendering provider is listed on all AHCCCS claims - the actual individual who provided care, not substitute providers except in locum tenens situations. For vaccine administration starting January 1, 2013: Bill both vaccine codes and administration codes separately. Use SL modifier on both vaccine and administration codes for VFC program patients under 18. Use CPT 90460/90461 for patients 18 and under with counseling, CPT 90471/90472 for patients over 18 or without counseling. Set vaccine charges to $0.00 for VFC program. Claims may be denied or result in recoupment without proper rendering provider documentation.