As previously indicated in our
Claims Processing Manual
, an Integrated Clinic is a provider licensed by the Arizona Department of Health Services as an Outpatient Treatment Center which provides both behavioral health services and physical health services.
In order to qualify for the above, providers must register as an integrated clinic with AHCCCS. When billing claims for payment, providers must submit their integrated clinic NPI in box 24J (or appropriate box for electronic submissions) for the claims to pay at the appropriate rate.
For the contracting year October 1, 2016 through September 30, 2017 (Contract Year Ending (CYE) 2017), providers who are registered with AHCCCS as Integrated Clinics (IC) during CYE 2017 may qualify for a Value Based Payment (VBP) Differential Adjusted Rate for selected services for those dates of service in CYE 2017 that coincide with the provider’s registration as an Integrated Clinic. The VBP Differential Adjusted Fee Schedule, which represents a positive adjustment to the AHCCCS Fee-For-Service rates, distinguishes providers who have committed to supporting designated actions that improve patients’ care experience, improve members’ health, and reduce cost of care growth. This fee schedule is currently limited to dates of service in CYE 2017. Mercy Care Plan has implemented this required change by AHCCCS.
VBP Differential Adjusted Rates will be paid for select physical health services and will provide an increase of 10% over the AHCCCS Fee-For-Service rates for the same services. Mercy Care is also required to provide a 10% increase over their contracted rates as well. Physical health services which qualify for the increase include Evaluation and Management (E&M) codes, vaccine administration codes, and a global obstetric code, which are all allowable as of April 1, 2016 for providers registered with AHCCCS as Integrated Clinics.
The specific list of codes are as follows:
59400
- Routine obstetric care including antepartum care, vaginal delivery (with or without episiotomy and/or forceps) and postpartum care
90471
- Immunization administration (includes percutaneous, intradermal, subcutaneous or intramuscular injections; 1 vaccine (single or combination vaccine/toxoid)
90472
- Immunization administration (includes percutaneous, intradermal, subcutaneous or intramuscular injections; each additional vaccine (single or combination vaccine/toxoid)
90473
- Immunization administration by intranasal or oral route; 1 vaccine (single or combination vaccine/toxoid)
90474
- Immunization administration by intranasal or oral route; each additional vaccine (single or combination vaccine/toxoid)
99201
- New patient office or other outpatient visit, typically 10 minutes
99202
- New patient office or other outpatient visit, typically 20 minutes
99203
- New patient office or other outpatient visit, typically 30 minutes
99204
- New patient office or other outpatient visit, typically 45 minutes
99205
- New patient office or other outpatient visit, typically 60 minutes
99211
- Office or other outpatient visit for the evaluation and management of an established patient, typically 5 minutes
99212
- Office or other outpatient visit for the evaluation and management of an established patient, typically 10 minutes
99213
- Office or other outpatient visit for the evaluation and management of an established patient, typically 15 minutes
99214
- Office or other outpatient visit for the evaluation and management of an established patient, visit typically 25 minutes
99215
- Office or other outpatient visit for the evaluation and management of an established patient, visit typically 40 minutes
99243
- Patient office consultation, typically 40 minutes
99244
- Patient office consultation, typically 60 minutes
99245
- Patient office consultation, typically 80 minutes
99381
- Initial comprehensive preventive medicine evaluation and management of an individual, including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnosis procedure, new patient; infant (age younger than 1 year)
99382
- Initial comprehensive preventive medicine evaluation and management of an individual, including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnosis procedure, new patient; early childhood (age 1 through 4 years)
99383
- Initial comprehensive preventive medicine evaluation and management of an individual, including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnosis procedure, new patient; late childhood (age 5 through 11 years)
99384
- Initial comprehensive preventive medicine evaluation and management of an individual, including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnosis procedure, new patient; adolescent (age 12 through 17 years)
99385
- Initial comprehensive preventive medicine evaluation and management of an individual, including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnosis procedure, new patient; 18 through 39 years)
99391
- Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnosis procedures, established patient, infant (age less than 1 year)
99392
- Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnosis procedures, established patient, early childhood (age 1 through 4 years)
99393
- Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnosis procedures, established patient, late childhood (age 5 through 11 years)
99394
- Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnosis procedures, established patient, adolescent (age 12 through 17 years)
99395
- Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnosis procedures, established patient, age 18 through 39 years
99403
- Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure; approximately 45 minutes
