What is AHCCCS? How does Medicaid coverage work for addiction treatment in Arizona?
Medicaid in Arizona is called the Arizona Health Care Cost Containment System, or AHCCCS, for short. The vast majority of services delivered through AHCCCS are delivered by managed care health plans, rather than fee-for-service providers. In fact, 94% of AHCCCS members receive their services this way. There are more than 2,200 behavioral health providers in Arizona serving AHCCCS members, and less than 10% of those providers operate on a fee-for-service basis.
What addiction treatment services are covered under AHCCCS aka Arizona Medicaid?
AHCCCS provides all of addiction treatment services that are typically covered under Medicaid plans, including:
Inpatient hospital services
Behavioral health inpatient facilities (BHIF)
Behavioral health residential facilities (BHRF)
“Partial care” or outpatient programs including supervised day programs, therapeutic day programs and medical day programs
Individual therapy and counseling
Group and/or family therapy and counseling
Emergency behavioral health services
Behavior management services
Evaluation and diagnosis services
Medication assisted treatment (methadone, etc)
Psychosocial rehabilitation (like job skills training and coaching)
Urinalysis and other laboratory testing
Residential substance use disorder treatment
Case management for SUD patients
Peer support services
There are some additional services available to Medicaid patients in Arizona that aren’t always included in other states’ programs. These include:
Childcare for parenting patients
Transportation to and from treatment
What are some of the most common CPT codes used in addiction treatment billing for Medicaid patients in Arizona?
According to the Fee-for-Service Provider Billing Manual, Chapter 19, Behavioral Health Services, AHCCCS covers many different types of behavioral health services for its members, including:
T1006 - Alcohol or substance use services, family/couple counseling
T1007 - Alcohol or substance use services, treatment plan development and or modification
T1009 - Babysitting services for parents who are receiving alcohol and/or substance abuse services
T1010 - Meals for patients who are receiving alcohol and/or drug abuse services
T1012 - Skills development services
S9475 - Ambulatory setting SUD services or detox services
G0396 - Alcohol and/or substance abuse assessment, 15-30 minutes long - can’t include smoking cessation services
G0397 - Alcohol and/or substance abuse assessment longer than 30 minutes - can’t include smoking cessation services
H2010 Comprehensive medication services, office, per 15 minutes; and/or
H0020 Alcohol and/or drug services; methadone administration and/or service (provision of the drug by a licensed program).
H0038 - Self-help/peer services, 15 minutes
H0038 HQ - Self-help/peer services, group setting
H0038 GT - Telemedicine peer support
H2016 - Comprehensive community support services, delivered for 3 or more hoursH2012 - Behavioral health day treatment, up to 5 hours in duration
H2015 - Comprehensive community support services, delivered for over 5 hours
H2019 - Therapeutic behavioral services
H2010 - Comprehensive medication services
H0020 - Alcohol and drug services, methadone administration and/or services (limited to one dose per day, per patient)
Does AHCCCS cover peer support services for addiction treatment patients?
Yes. Peer support services are covered in most states’ Medicaid plans, including Arizona’s plan. Billing AHCCCS for peer support services is typically done in 15 minute increments under the CPT code, H0038. When peer support services are delivered in a group setting, the “HQ” modifier is added, making the correct CPT code for group peer support services H0038 HQ. When peer support services are delivered via telehealth, which is allowed in many circumstances for Arizona AHCCCS patients, the “GT” modifier is added, making the appropriate CPT code for telehealth peer support services H0038 GT.
Does Medicaid in Arizona cover sober living homes?
No. Medicaid will not reimburse for room or board at a recovery residence in Arizona.
Are addiction treatment Medicaid scams and fraudulent billing practices prevalent in Arizona?
Unfortunately, yes.
There have been recent reports of fraudulent and/or poorly run programs purporting to offer addiction treatment services, especially in the vicinity of Phoenix, Arizona. Many of these programs target Native Americans. Frequently, non-medical transport vans find would-be patients on reservations and promise them free transport and treatment in a far-away facility. Once there, patients find that the services they were promised are lackluster at best and they’re often stranded in a far-away place without community support or a ride home. These programs bill Arizona Medicaid through the American Indian Health Program, a part of AHCCCS that specifically serves Native Americans. Native American activists, community organizations and legislators have taken steps to curb these predatory practices on reservations, including the Navajo Nation’s Operation Rainbow Bridge.
Other Medicaid scams that are prevalent in Arizona don’t necessarily target Native Americans, but instead bill long residential stays for deceased patients, incarcerated patients or patients who only receive treatment for a single day.
It goes without saying that billing Medicaid for addiction treatment services should be done with the utmost integrity and respect for patients and the Medicaid system. At Behave Health, we’re committed to helping providers maintain ethical and efficient Medicaid billing practices.
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