MedicaidBilling CodesHigh impact
AHCCCS DFSM Claims Clues - Intensive Outpatient Program (IOP) Coding Clarification
Arizona Medicaid - AHCCCS·AZ · Psychiatry·Claims & Billing
Effective date
Mar 25, 2024
We identified it
Jun 17, 2026
Summary
AHCCCS has clarified strict requirements for billing codes S9480 and H0015 for Intensive Outpatient Program (IOP) services due to concerns about providers not meeting service level requirements. The policy establishes minimum weekly hour requirements, staffing ratios, and operational standards that must be met to use these codes.
Action Required
Immediately: Review all current IOP billing practices for codes S9480 and H0015. For S9480: Ensure minimum 9 hours/week service with required psychiatric provider sessions, individual counseling, and group sessions. Verify BHMP availability 80% of time, BHP caseloads under 16 members, and group sessions limited to 8 members. For H0015: Confirm minimum 9 hours/week over at least 3 days with substance use disorder treatment aligned to ASAM Level 2.1 criteria. Stop billing these codes if requirements cannot be met to avoid claim denials.