Azahcccs.gov
Given the High Cost Behavioral Health Reinsurance program was discontinued for new members starting in 2007, and only continues to apply to certain members that were grandfathered in, AHCCCS will not be updating the original service list below.? Service TypeCodeLOA/Nursing Home 0185Subacute Care Level I0191Subacute Care Level II0192Subacute Care Level III0193Subacute Care Level IV0194Other Subacute Care0199Ambulance Service, Basic Life Support (BLS), BLS RateA0010Non-Emergency Transportation, per mile – Vehicle provided by VolunteerA0080Non-Emergency Transportation, per mile – Vehicle provided by Individual (Family)A0090Non-Emergency Transportation: TaxiA0100Non-Emergency Transportation: Mini-Bus, Mountain Area Transport, or OtherA0120Non-Emergency Transportation; Wheelchair VanA0130Non-Emergency Transportation and Air Travel (Private or Commercial) Intra- or Inter-StateA0140Non-Emergency Transportation, per mile – Case Worker or Social WorkerA0160Ground Mileage, per statute mileA0425Ambulance Service, Advanced Life Support (ALS), Non-Emergency Transport, Level 1 (ALS 1)A0426Ambulance Service, Basic Life Support, Non-Emergency Transport (BLS)A0428Fixed Wing Air Mileage, per statute mileA0435Behavioral Health; Short-Term Residential (Non-Hospital Residential Treatment Program), Without Room and Board, per diemH0018Behavioral Health; Long-Term Residential (Non-Medical, Non-Acute Care in a Residential Treatment Program where stay is typically longer than 30 days), Without Room and Board, per diemH0019Behavioral Health Prevention Education Service (Delivery of Services with Target Population to Affect Knowledge, Attitude and/or Behavior)H0025Medication Training and Support, per 15 minutesH0034Mental Health Partial Hospitalization, Treatment, less than 24 hoursH0035Community Psychiatric Supportive Treatment, Face to Face, per 15 minutesH0036Community Psychiatric Supportive Treatment Program, per diemH0037Behavioral Health Day Treatment, per hourH2012Skills Training and Development, per 15 minutesH2014Comprehensive Community Support Services, per 15 minutesH2015Comprehensive Community Support Services, per diemH2016Psychosocial Rehabilitation Services, per 15 minutesH2017Therapeutic Behavioral Services, per 15 minutesH2019Therapeutic Behavioral Services, per diemH2020Ongoing Support to Maintain Employment, per 15 minutesH2025Ongoing Support to Maintain Employment, per diemH2026Psychoeducational Service, per 15 minutesH2027Wheelchair Van, Mileage, per mileS0209Non-Emergency Transportation, Mileage, per mileS0215Day Care Services, Adult, per 15 minutesS5100Day Care Services, Adult, per half dayS5101Day Care Services, Adult, per diemS5102Home Care Training to Home Care Client, per sessionS5109Home Care Training, Family; per 15 minutesS5110Attendant Care Services, per 15 minutesS5125Homemaker Service, Not Otherwise Specified (NOS), per 15 minutesS5130Foster Care, Adult, per diemS5140Foster Care, Therapeutic, Child, per diemS5145Unskilled Respite Care, Not Hospice, per 15 minutesS5150Unskilled Respite Care, Not Hospice, per diemS5151Home Delivered Meals, Including Preparation, per mealS5170Nursing Care, In the Home, by Registered Nurse, per hour (Use for General Nursing Care only, not to be used when CPT Codes 99500-99602 can be used)S9123Nursing Care, In the Home, by Licensed Practical Nurse, per hourS9124Personal Care Services, per 15 minutes, Not for an inpatient or resident of a hospital, nursing facility, ICF/DD or IMD, Part of the Individualized Plan of Treatment (Code may not be used to identify services provided by Home Health Aide or Certified Nurse Assistant)T1019Personal Care Services, per diem, Not for an inpatient or resident of a hospital, nursing facility, ICF/DD or IMD, Part of the Individualized Plan of Treatment, (Code may not be used to identify services provided by Home Health Aide or Certified Nurse Assistant)T1020Home Health Aide or Certified Nurse Assistant, per visitT1021Non-Emergency Transportation, Stretcher VanT2005Habilitation, Residential, Waiver, per diemT2016Habilitation, Residential, Waiver, per 15 minutesT2017Day Habilitation, Waiver, per 15 minutesT2021Assisted Living, Waiver, per diemT2031Residential Care, Not Otherwise Specified (NOS), Waiver, per diemT2033Non-Emergency Transportation, Stretcher Van, Mileage, per mileT2049 ................
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