Arizona Administrative Code
Title 9 - HEALTH SERVICES
Chapter 22 - ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - ADMINISTRATION
Article 7 - STANDARDS FOR PAYMENTS
Section R9-22-712.09 - Hierarchy for Tier Assignment through September 30, 2014
Universal Citation: AZ Admin Code R 9-22-712.09
Current through Register Vol. 30, No. 38, September 20, 2024
| TIER | IDENTIFICATION CRITERIA | ALLOWED SPLITS |
| MATERNITY | A primary diagnosis defined as maternity 640.xx - 643.xx, 644.2x - 676.xx, v22.xx - v24.xx or v27.xx. | None |
| NICU | Revenue Code of 174 and the provider has a Level II or Level III NICU. | Nursery |
| ICU | Revenue Codes of 200-204, 207-212, or 219. | Surgery Psychiatric Routine |
| SURGERY | Surgery is identified by a revenue code of 36x. To qualify in this tier, there must be a valid surgical procedure code that is not on the excluded procedure list. | ICU |
| PSYCHIATRIC | Psychiatric Revenue Codes of 114, 124, 134, 144, or 154 AND primary Psychiatric Diagnosis = 290.xx - 316.xx. If a routine revenue code is present and all diagnoses codes on the claim are equal to 290.xx - 316.xx, classify as a psychiatric claim. | ICU |
| NURSERY | Revenue Code of 17x, not equal to 174. | NICU |
| ROUTINE | Revenue Codes of 100 - 101, 110-113, 116 - 123, 126 - 133, 136 - 143, 146 - 153, 156 - 159, 16x, 206, 213, or 214. | ICU |
Disclaimer: These regulations may not be the most recent version. Arizona may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
This site is protected by reCAPTCHA and the Google
Privacy Policy and
Terms of Service apply.
