For which client would the nurse conduct a developmental surveillance during a scheduled health maintenance visit?

Provider billing guides and fee schedules

This page contains billing guides, fee schedules, and additional billing materials to help you submit:

• Prior authorization (PA) for services
• Claims

Coronavirus (COVID-19) information. For general Apple Health and behavioral health guidance, visit our Information about novel coronavirus (COVID-19) webpage. For telehealth policies and FAQs, see Telehealth on this page.

Notice: Past billing guides may have broken links. If this occurs, please refer to the most recent guide.

On this page

Prior authorization (PA)

Before you provide certain services, you will need to submit authorization request forms. Use the ProviderOne portal to see if a client is eligible for the service and the billing guides and fee schedules to determine if a PA is required.

For step-by-step instructions on completing a PA, visit our Prior authorization (PA) page.

Claims

After you complete a service, you file claims through the ProviderOne portal. Use the billing guides and fee schedules to find rate information and the ProviderOne Billing and Resource Guide to walk through the claims process.

Do you need a barcode cover sheet? Visit our Document submission cover sheets page to find the barcode cover sheets required with additional documentation.

Billing guides and fee schedules

Use our billing guides and fee schedules to determine if a PA is required and assist in filing claims.

Questions? For questions about billing guides, contact the Medical Assistance Customer Service Center (MACSC) online or at 1-800-562-3022. For questions about rates or fee schedules, email .

Jump to the first list item for each letter: A B C D E F G H I J K L M N O P Q R S T U V W X Y Z

Ambulance transportation

Billing guides

Ambulance transportation

• January 1, 2021 to present — Ambulance transportation billing guide
• July 1, 2020 to December 31, 2020 — Ambulance transportation billing guide
• April 1, 2020 to June 30, 2020 — Ambulance transportation billing guide
• View all ITA transportation billing guides

Ground Emergency Medical Transportation (GEMT)

• July 1, 2022 to present - Ground Emergency Medical Transportation (GEMT) billing guide
• October 1, 2020 to June 30, 2022 — Ground Emergency Medical Transportation (GEMT) billing guide
• January 1, 2020 to September 30, 2020 — Ground Emergency Medical Transportation (GEMT) billing guide
• May 1, 2019 to December 31, 2019 — Ground Emergency Medical Transportation (GEMT) billing guide
• View all GEMT billing guides

Fee schedules

• July 1, 2021 to present — Ambulance transportation (updated August 12, 2021)
• February 29, 2020 to June 30, 2021 — Ambulance transportation (updated April 17, 2020)
• July 1, 2019 to February 28, 2020— Ambulance transportation (updated May 29, 2019)
• December 1, 2016 to June 30, 2019 — Ambulance transportation (updated December 09, 2016)
• January 1, 2006 to November 30, 2016 — Ambulance transportation (updated February 10, 2016)

Additional materials

• Treat and refer attestation
• Transportation matrix

Ambulatory surgery centers (ASCs)

Billing guides

• July 1, 2022 to present - ACS billing guide
• July 1, 2021 to June 30, 2022 — ASC billing guide
• October 1, 2020 to June 30, 2021— ASC billing guide
• View all ASC billing guides

Fee schedules

• April 1, 2022 to present -- ASC fee schedule (updated August 12, 2022)
• October 1, 2021 to March 31, 2022 -- ASC fee schedule (updated December 16, 2021)
• March 1, 2021 to September 30, 2021 -- ASC fee schedule (updated June 8, 2021)
• View all ASC fee schedules

Applied behavior analysis (ABA)

Billing guides

• August 1, 2022 to present - ABA billing guide
• April 29, 2022 to July 31, 2022 - ABA billing guide
• April 1, 2022 to April 28, 2022 - ABA billing guide
• View all ABA billing guides

Fee schedules

• July 1, 2022 to present — ABA fee schedule (published June 29, 2022)
• July 1, 2021 to June 30, 2022 — ABA fee schedule (published June 30, 2021)
• July 1, 2020 to June 30, 2021 — ABA fee schedule (published June 29, 2020)
• View all ABA fee schedules

Centers of Excellence

• ABA COE fee-for-service provider directory

Blood bank services

Billing guides

Discontinued 3/31/2013. Refer to the current Physician-related/professional services for information regarding blood, blood products, and related services.

Fee schedules

• July 1, 2022 to present — Blood bank fee schedule (published June 29, 2022)
• July 1, 2021 to June 30, 2022 — Blood bank fee schedule (published July 1, 2021)
• July 1, 2020 to June 30, 2021 — Blood bank fee schedule (published June 30, 2020)
• View all Blood Bank services fee schedules

Chiropractic services for children

Billing guides

• July 1, 2022 to present - Chiropractic services billing guide
• October 1, 2020 to June 30, 2022 — Chiropractic services billing guide
• January 1, 2020 to September 30, 2020 — Chiropractic services billing guide
• View all chiropractic services for children billing guides

Fee schedules

• July 1, 2022 to present — Chiropractic services for children fee schedule (published June 29, 2022)
• July 1, 2021 to June 30, 2022 — Chiropractic services for children fee schedule (published June 30, 2021)
• July 1, 2020 to June 30, 2021 — Chiropractic services for children fee schedule (updated March 15, 2021)
• View all chiropractic services for children fee schedules

Complex rehabilitation technology (CRT)

Billing guides

• July 1, 2022 to present - CRT products and services billing guide
• January 1, 2022 to June 30, 2022 - CRT products and services billing guide
• October 1, 2020 - December 31, 2021 — CRT products and services billing guide
• View all CRT billing guides

Fee schedules

• July 1, 2022 to present — CRT fee schedule (updated July 14, 2022)
• April 1, 2022 to June 30, 2022 — CRT fee schedule (published March 30, 2022)
• July 1, 2021 to March 31, 22 — CRT fee schedule (updated November 3, 2021)
• View all CRT fee schedules

Social Services

• Social services supplement (updated October 1, 2020)
• September 1, 2021 to present - Social services blanket codes
• November 17, 2020 to August 31, 2021 - Social services blanket codes
• View all social services blanket codes

COVID-19

Fee schedules

• July 1, 2022 to present — COVID-19 fee schedule (updated July 28, 2022)
• January 1, 2022 to June 30, 2022 — COVID-19 fee schedule (updated May 26, 2022)
• July 1, 2021 to December 31, 2021 — COVID-19 fee schedule (updated November 4, 2021)
• View all COVID-19 fee schedules

Policies and billing guidance

Apple Health COVID-19 vaccine policy

• August 1, 2022 to present - Apple Health COVID-19 vaccine policy
• June 17, 2022 to July 31, 2022 - Apple Health COVID-19 vaccine policy
• June 1, 2022 to June 16, 2022 - Apple Health COVID-19 vaccine policy
• View all COVID-19 vaccine policies

Apple Health Monoclonal Antibody Treatment COVID-19 clinical policy

• May 10, 2022 to present - Apple Health Monoclonal Antibody Treatment COVID-19 clinical policy

• April 12, 2022 to May 9, 2022 - Apple Health Monoclonal Antibody Treatment COVID-19 clinical policy

• March 23, 2022 to April 11, 2022 - Apple Health Monoclonal Antibody Treatment COVID-19 clinical policy
• View all Monoclonal Antibody Treatment COVID-19 clinical policies

Apple Health COVID-19 testing clinical policy

• March 4, 2022 to present - Apple Health COVID-19 testing clinical policy
• January 24, 2022 to March 3, 2022 - Apple Health COVID-19 testing clinical policy
• October 1, 2021 to January 23, 2022 - Apple Health COVID-19 testing clinical policy
• View all COVID-19 testing clinical policies

Dental Program

Billing guides

Access to Baby and Child Dentistry (ABCD)

See Access to Baby and Child Dentistry (ABCD).

Dental-related services

• August 1, 2022 to present - Dental-related services program billing guide
• July 1, 2022 to July 31, 2022 - Dental-related services program billing guide
• April 1, 2022 to June 30, 2022 - Dental-related services program billing guide
• View all dental services billing guides

Oral Health Connections (OHC) pilot project

• July 1, 2022 to present - Oral Health Connections pilot project billing guide
• January 1, 2022 to June 30, 2022 - Oral Health Connections pilot project billing guide
• October 1, 2020 to December 31, 2021 — Oral Health Connections pilot project billing guide
• View all OHC pilot project billing guides

Mobile anesthesia

• July 1, 2022 to present - Mobile anesthesia for dental services billing guide

Fee schedules

• July 1, 2022 to present — Dental program fee schedule (published June 29, 2022)
• January 1, 2022 to June 30, 2022 — Dental program fee schedule (updated December 29, 2021)
• July 1, 2021 to December 31, 2021 — Dental program fee schedule (updated August 3, 2021)
• View all dental services fee schedules

Diabetes Education Program

Billing guides

• July 1, 2022 to present - Diabetes education program billing guide
• July 1, 2021 to June 30, 2022 — Diabetes education program billing guide
• April 1, 2021 to June 30, 2021 — Diabetes education program billing guide
• View all Diabetes Education Program billing guides

Fee schedules

• July 1, 2022 to present — Diabetes education (published June 29, 2022)
• July 1, 2021 to June 30, 2022 — Diabetes education (published June 30, 2021)
• July 1, 2020 to June 30, 2021 — Diabetes education (published June 29, 2020)
• View all diabetes education fee schedules

Durable medical equipment (DME)

Billing guides

• April 1, 2019 to present — Refer to the Medical Equipment and Supplies billing guide for information regarding durable medical equipment.
• January 1, 2019 to March 31, 2019 — DME and non-CRT wheelchairs billing guide
• October 1, 2018 to December 31, 2018 — DME and non-CRT wheelchairs billing guide
• July 1, 2018 to September 30, 2018 — DME and non-CRT wheelchairs billing guide
• View all DME billing guides

Fee schedules

• April 1, 2019 to present — Refer to the Medical Equipment and Supplies fee schedules

Other DME

• January 1, 2019 to March 31, 2019 — Other DME fee schedule (updated December 3, 2019)

Standard wheelchairs and accessories

• January 1, 2019 to March 31, 2019 — Wheelchairs and accessories fee schedule (updated December 3, 2019)

Additional materials

• View all DME social services blanket codes

Early and periodic screening, diagnosis and treatment (EPSDT)

Billing guides

• July 1, 2022 to present - EPSDT program billing guide
• April 1, 2022 to June 30, 2022 - EPSDT program billing guide
• April 1, 2021 to March 31, 2022 — EPSDT program billing guide
• View all EPSDT billing guides

Fee schedules

• July 1, 2022 to present — EPSDT fee schedule (updated August 2, 2022)
• July 1, 2021 to June 30, 2022 — EPSDT fee schedule (published June 30, 2021)
• July 1, 2020 to June 30, 2021 — EPSDT fee schedule (published June 29, 2020)
• View all EPSDT fee schedules

Periodicity schedules

• ​ EPSDT periodicity schedule (Updated April 1, 2021)

Enteral nutrition

Billing guides

• September 1, 2022 to present - Enteral nutrition billing guide
• July 1, 2022 to August 31, 2022 - Enteral nutrition billing guide
• April 1, 2021 to June 30, 2022 — Enteral nutrition billing guide
• View all enteral nutrition billing guides

Fee schedules

• July 1, 2022 to present — Enteral nutrition fee schedule (updated July 5, 2022)
• July 1, 2021 to June 30, 2022 — Enteral nutrition fee schedule (updated November 3, 2021)
• July 1, 2020 to June 30, 2021 — Enteral nutrition fee schedule (updated July 21, 2020)
• View all enteral nutrition fee schedules

Family planning

Billing guides

• July 1, 2022 to present - Family planning billing guide
• February 1, 2022 to June 30, 2022 - Family planning billing guide
• October 1, 2021 to January 31, 2022 — Family planning billing guide
• View all family planning billing guides

Family planning fee schedules

• July 1, 2022 to present — Family planning fee schedule (published June 29, 2022)
• January 1, 2022 to June 30, 2022 — Family planning fee schedule (updated February 7, 2022)
• October 1, 2021 to December 31, 2021 — Family planning fee schedule (updated October 5, 2021)
• View all family planning fee schedules

SRHP fee schedules

• July 1, 2022 to present — SRHP fee schedule (published June 29, 2022)

• October 1, 2021 to June 30, 2022 — SRHP fee schedule (updated April 4, 2022)

Additional materials

• Sterilization Supplemental Billing Guide
• Physician-Related Services/Health Care Professional Services Billing Guide
• Physician administered drugs fee schedule
• Prescription Drug Program Billing Guide

Family planning

• Family planning only program telemedicine services offered during the COVID-19 outbreak (March 2020)
• Family planning program (family planning non-Medicaid)
• Family planning client application (form 13-781)

Federally qualified health centers (FQHCs)

Billing guides

• August 1, 2022 to present FQHC billing guide
• July 1, 2022 to July 31, 2022 -FQHC billing guide
• April 1, 2022 to June 30, 2022 - FQHC billing guide
• View all FQHC billing guides

Encounter rates

• July 1, 2022 to present — FQHC encounter rates (updated July 21, 2022)
• April 1, 2022 to June 30, 2022 — FQHC encounter rates (updated July 21, 2022)
• January 1, 2022 to March 31, 2022 — FQHC encounter rates (updated July 21, 2022)
• View all FQHC encounter rates

Enhancement rates

• July 1, 2022 to present — FQHC enhancement rates (updated August 9, 2022)
• April 1, 2022 to June 30, 2022 — FQHC enhancement rates (updated August 9, 2022)
• January 1, 2022 to March 31, 2022 — FQHC enhancement rates (updated August 9, 2022)
• View all FQHC enhancement rates

Habilitative services

Billing guides

• August 1, 2022 to present- Habilitative services program billing guide
• July 1, 2022 to July 31, 2022 - Habilitative services program billing guide
• January 1, 2022 to June 30, 2022 - Habilitative services program billing guide
• View all habilitative services billing guides

Fee schedules

• July 1, 2022 to present — Habilitative services (published June 29, 2022)
• July 1, 2021 to June 30, 2022 — Habilitative services (published June 30, 2021)
• January 1, 2021 to June 30, 2021 — Habilitative services (updated January 4, 2021)
• View all habilitative services fee schedules

Hearing hardware

For Apple Health clients and clients of the Developmental Disabilities Administration.

Billing guides

• April 1, 2022 to present - Hearing hardware billing guide
• November 1, 2020 to March 31, 2022 — Hearing hardware billing guide
• October 1, 2020 to October 31, 2020 — Hearing hardware billing guide
• View all hearing hardware billing guides

Fee schedules

• July 1, 2022 to present — Hearing hardware fee schedule (published June 29, 2022)
• April 1, 2022 to June 30, 2022 — Hearing hardware fee schedule (published March 30, 2022)
• July 1, 2021 to March 30, 2022 — Hearing hardware fee schedule (published July 8, 2021)
• View all hearing hardware fee schedules

Social Services

• Social services supplement (updated October 1, 2020)
• September 1, 2021 to present - Social services blanket codes
• November 17, 2020 to August 31, 2021 - Social services blanket codes
• View all social services blanket codes

Home health services (acute care services)

Billing guides

• July 1, 2022 to present - Home health (acute care services) billing guide
• April 1, 2022 to June 30, 2022 - Home health (acute care services) billing guide
• February 1, 2022 to March 31, 2022 - Home health (acute care services) billing guide
• View all home health services billing guides

Fee schedules

• July 1, 2022 to present — Home health fee schedule (published June 29, 2022)
• January 1, 2022 to June 30, 2022 — Home health fee schedule (updated January 31, 2022)
• July 1, 2021 to December 31, 2021 — Home health fee schedule (updated October 12, 2021)
• View all home health services fee schedules

Home infusion therapy/parenteral nutrition

Billing guides

• October 1, 2021 to present - Home Infusion therapy billing guide
• January 1, 2021 to September 30, 2021 - Home Infusion therapy billing guide
• October 1, 2020 to December 31, 2020 — Home Infusion therapy billing guide
• View all home infusion therapy and nutrition billing guides

Fee schedules

• July 1, 2022 to present — Home infusion therapy/parenteral nutrition fee schedule (updated July 14, 2022)
• July 1, 2021 to June 30, 2022 — Home infusion therapy/parenteral nutrition fee schedule (updated April 1, 2022)
• January 1, 2021 to June 30, 2021 — Home infusion therapy/parenteral nutrition fee schedule (published December 22, 2020)
• View all home infusion therapy/parenteral nutrition fee schedules

Social Services

• Social services supplement (updated October 1, 2020)
• September 1, 2021 to present - Social services blanket codes
• November 17, 2020 to August 31, 2021 - Social services blanket codes
• View all social services blanket codes

Hospice

Billing guides

• July 1, 2022 to present - Hospice services billing guide
• October 1, 2020 to June 30, 2022 — Hospice services billing guide
• January 1, 2020 to September 30, 2020 — Hospice services billing guide
• View all hospice billing guides

Fee schedules

• October 1, 2021 to present — Hospice fee schedule (published September 29, 2021)
• October 1, 2020 to September 30, 2021 — Hospice fee schedule (published September 21, 2020)
• October 1, 2019 to September 30, 2020 — Hospice fee schedule (published September 30, 2019)

Kidney center services

Billing guides

• July 1, 2022 to present - Kidney center services billing guide
• January 1, 2022 to June 30, 2022 - Kidney center services billing guide
• January 1, 2021 to December 31, 2021 - Kidney center services billing guide
• View all kidney center services billing guides

Fee schedules

• July 1, 2022 to present — Kidney centers fee schedules (updated August 8, 2022)
• April 1, 2022 to June 30, 2022 — Kidney centers fee schedules (updated August 8, 2022)
• January 1, 2022 to March 31, 2022 — Kidney centers fee schedules (published December 29, 2021)
• View all kidney center services fee schedules

Maternity support services/infant case management (MSS/ICM)

Billing guides

• August 1, 2022 to present - MSS/ICM billing guide 
• July 1, 2022 to July 31, 2022 - MSS/ICM billing guide
• January 1, 2021 to June 30, 2022 - MSS/ICM billing guide
• View all MSS/ICM billing guides

Fee schedules

• July 1, 2020 to present — MSS/ICM fee schedule (published July 1, 2020)
• January 1, 2020 to June 30, 2020 — MSS/ICM fee schedule (published January 9, 2020)
• October 1, 2015 to December 31, 2019 — MSS/ICM fee schedule (published October 7, 2015)

Medical equipment and supplies

Billing guides

• July 1, 2022 to present - Medical Equipment and Supplies Billing Guide
• January 1, 2022 to June 30, 2022 - Medical Equipment and Supplies Billing Guide
• October 18, 2021 to December 31, 2021 - Medical Equipment and Supplies Billing Guide
• View all Medical equipment and supplies billing guides

Fee schedules

• July 1, 2022 to present — Medical Equipment and Supplies fee schedule (updated July 25, 2022)
• January 1, 2022 to June 30, 2022 — Medical Equipment and Supplies fee schedule (updated January 3, 2022)
• October 1, 2021 to December 31, 2021 — Medical Equipment and Supplies fee schedule (updated November 3, 2021)
• View all medical equipment and supplies fee schedules

Social Services

• Social services supplement (updated October 1, 2020)
• September 1, 2021 to present - Social services blanket codes
• November 17, 2020 to August 31, 2021 - Social services blanket codes
• View all social services blanket codes

Medical nutrition therapy

Billing guides

• August 1, 2022 to present - Medical nutrition therapy billing guide
• July 1, 2022 to July 31, 2022 - Medical nutrition therapy billing guide
• October 1, 2020 to June 30, 2022 — Medical nutrition therapy billing guide
• View all medical nutrition therapy billing guides

Fee schedules

• July 1, 2022 to present — Medical nutrition therapy fee schedule (published June 29, 2022)
• July 1, 2021 to June 30, 2022 — Medical nutrition therapy fee schedule (published June 30, 2021)
• July 1, 2020 to June 30, 2021 — Medical nutrition therapy fee schedule (published July 1, 2020)
• View all medical nutrition therapy fee schedules

Social Services

• Social services supplement (updated October 1, 2020)
• September 1, 2021 to present - Social services blanket codes
• November 17, 2020 to August 31, 2021 - Social services blanket codes
• View all social services blanket codes

Mental health services

Billing guides

• August 1, 2022 to present - Mental health services billing guide
• July 1, 2022 to July 31, 2022 - Mental health services billing guide
• April 1, 2022 to June 30, 2022 - Mental health services billing guide
• View all mental health services billing guides

Integrated Managed Care (IMC) Service Encounter Reporting

• SERI instructions and interim guidance

Fee schedules

Mental health services

• July 1, 2022 to present — Mental health and psychology services fee schedule (published June 29, 2022)
• January 1, 2022 to June 30, 2022 — Mental health and psychology services fee schedule (updated January 10, 2022)
• October 1, 2021 to December 31, 2021 — Mental health and psychology services fee schedule (updated January 10, 2022)
• View all mental health services fee schedules

Specialized mental health services

• July 1, 2022 to present — Specialized mental health fee schedule (published June 29, 2022)
• January 1, 2022 to June 30, 2022 — Specialized mental health fee schedule (published April 4, 2022)
• October 1, 2021 to December 31, 2021 — Specialized mental health fee schedule (updated November 19, 2021)
• View all specialized mental health services fee schedules

Additional materials

• How do providers identify the correct payer?

Neurodevelopmental centers

Billing guides

• August 1, 2022 to present - Neurodevelopmental centers billing guide
• July 1, 2022 to July 31, 2022 - Neurodevelopmental centers billing guide
• July 1, 2021 to June 30, 2022 — Neurodevelopmental centers billing guide
• View all neurodevelopmental centers billing guides

Fee schedules

• July 1, 2022 to present — Neurodevelopmental centers fee schedule (published June 29, 2022)
• July 1, 2021 to June 30, 2022 — Neurodevelopmental centers fee schedule (published June 30, 2021)
• January 1, 2021 to June 30, 2021 — Neurodevelopmental centers fee schedule (updated January 4, 2021)
• View all neurodevelopmental centers fee schedules

Outpatient hospital

Billing guides

• August 1, 2022 to present - Outpatient hospital services billing guide
• July 1, 2022 to July 31, 2022 - Outpatient hospital services billing guide
• April 1, 2022 to June 30, 2022 - Outpatient hospital services billing guide
• View all outpatient billing guides

Fee schedules

• July 1, 2022 - present -- OPPS fee schedule (updated August 11, 2022)
• April 1, 2022 - June 30, 2022 - OPPS fee schedule (updated June 28, 2022)
• January 1, 2022 to March 31, 2022 -- OPPS fee schedule (updated June 28, 2022)
• October 1, 2021 to December 31, 2021 -- OPPS fee schedule (updated June 24, 2022)
• View all outpatient fee schedules

Additional information

• HCA revenue code grids
• Guidance for billing MCOs for services provided to newborns

Outpatient Rehabilitation Program

Billing guides

• August 1, 2022 to present - Outpatient rehabilitation billing guide
• July 1, 2022 to July 31, 2022 - Outpatient rehabilitation billing guide
• January 1, 2022 to June 30, 2022 - Outpatient rehabilitation billing guide
• View all Outpatient Rehabilitation Program billing guides

Fee schedules

• July 1, 2022 to present — Outpatient rehabilitation fee schedule (published June 29, 2022)
• July 1, 2021 to June 30, 2022 — Outpatient rehabilitation fee schedule (published June 30, 2021)
• January 1, 2021 to June 30, 2021 — Outpatient rehabilitation fee schedule (updated January 4, 2021)
• View all Outpatient Rehabilitation Program fee schedules

Social Services

• Social services supplement (updated October 1, 2020)
• September 1, 2021 to present - Social services blanket codes
• November 17, 2020 to August 31, 2021 - Social services blanket codes
• View all social services blanket codes

Physician-related/professional services

Billing guides

• August 1, 2022 to present - Physician-related services/health care billing guide
• July 1, 2022 to July 31, 2022 - Physician-related services/health care billing guide
• June 11, 2022 to June 30, 2022 - Physician-related services/health care billing guide
• View all physician-related/professional services billing guides

Physician-related/professional services fee schedules

• July 1, 2022 to present — Physician-related services fee schedules (updated August 15, 2022)
• April 1, 2022 to June 30, 2022 — Physician-related services fee schedules (updated May 10, 2022)
• January 1, 2022 to March 31, 2022 — Physician-related services fee schedules (updated March 8, 2022)
• View all physician-related/professional services fee schedules

Enhanced pediatric fee schedules

• July 1, 2022 to present — Enhanced pediatric fee schedule (published June 29, 2022)
• October 1, 2021 to June 30, 2022 — Enhanced pediatric fee schedule (published September 29, 2021)
• July 1, 2021 to September 30, 2021 — Enhanced pediatric fee schedule (published June 30, 2021)
• View all enhanced pediatric fee schedules

Enhanced adult primary care fee schedules

• July 1, 2022 to present — Enhanced adult primary care fee schedule (published June 29, 2022)

• October 1, 2021 to June 30, 2022 — Enhanced adult primary care fee schedule (published September 29, 2021)

Medication for Opioid Use Disorder (MOUD) fee schedules

• July 1, 2022 to present — Opioid use disorder fee schedule (published June 29, 2022)
• July 1, 2021 to June 30, 2022 — Opioid use disorder fee schedule (published June 30, 2021)
• January 1, 2021 to June 30, 2021 — Opioid use disorder fee schedule (published December 23, 2020)
• View all medication for opioid use disorder fee schedules

Conversion factors

• July 1, 2022 to present — Conversion factors (published June 29, 2022)
• July 1, 2021 to June 30, 2022 — Conversion factors (published June 30, 2021)
• July 1, 2020 to June 30, 2021 — Conversion factors (published June 30, 2020)
• View all conversion factors

Additional materials

• Hysterectomy Form [13-365]
• Sterilization Supplemental Billing Guide
• Family Planning Billing Guide
• Guidance for billing MCOs for services provided to newborns
• Centers of Excellence: organ transplant facilities directory

Planned home births and births in birth centers

Billing guides

• June 11, 2022 to present - Planned home births and births in centers billing guide
• April 1, 2022 to June 10, 2022 - Planned home births and births in centers billing guide
• January 1, 2022 to March 31, 2022 - Planned home births and births in centers billing guide
• View all planned home births billing guides

Fee schedules

• July 1, 2022 to present — Planned home births and births in centers fee schedule (published June 29, 2022)
• July 1, 2021 to June 30, 2022 — Planned home births and births in centers fee schedule (published June 30, 2021)
• July 1, 2020 to June 30, 2021 — Planned home births and births in centers fee schedule (updated July 27, 2020)
• View all planned home births fee schedules

Prescription Drug Program

Billing guides

• April 1, 2022 to present - Prescription drug program billing guide
• October 1, 2021 to March 31, 2022 - Prescription drug program billing guide
• September 1, 2021 to September 30, 2021 - Prescription drug program billing guide
• View all billing guides

Apple Health (Medicaid) expedited authorization (EA) lists

• June 1, 2022 to present - Expedited authorization codes and criteria table
• December 1, 2021 to May 31, 2022 - Expedited authorization codes and criteria table
• July 1, 2021 to November 30, 2021 - Expedited authorization codes and criteria table
• View all EA lists

For previous versions, email us .

Apple Health (Medicaid) preferred drug lists (PDLs)

Managed care plans and fee-for-service (FFS) plans

All agency-contracted managed care organizations (MCOs) and the fee-for-service (FFS) program use the Apple Health PDL.

The Apple Health PDL can be found on the agency’s Apple Health PDL page.

FFS state maximum allowable cost (SMAC) list

• Current SMAC list

To request an FFS change in reimbursement

Download the Pharmacy Information Authorization form (13-835A). Fax the request to: 866-668-1214.

Private duty nursing

Billing guides

• July 1, 2022 to present - Private duty nursing for children billing guide
• October 1, 2020 to June 30, 2022 - Private duty nursing for children billing guide
• July 17, 2020 to September 30, 2020 - Private duty nursing for children billing guide
• View all private duty nursing for children billing guides

Fee schedules

• January 1, 2020 to present — Private duty nursing fee schedule (published December 19, 2019)
• July 1, 2016 to December 31, 2019 — Private duty nursing fee schedule (published June 22, 2016)

Social Services

• Social services supplement (updated October 1, 2020)
• View all social services blanket codes

Prosthetics and orthotics

Billing guides

• July 1, 2022 to present - Prosthetic and orthotic devices billing guide
• April 1, 2022 to June 30, 2022 - Prosthetic and orthotic devices billing guide
• October 1, 2021 to March 31, 2022 — Prosthetic and orthotic devices billing guide
• View all prosthetic and orthotics billing guides

Fee schedules

• July 1, 2022 to present — Prosthetic and orthotics fee schedule (updated July 21, 2022)
• October 1, 2021 to June 30, 2022 — Prosthetic and orthotics fee schedule (updated November 19, 2021)
• July 1, 2021 to September 30, 2021 — Prosthetic and orthotics fee schedule (updated November 19, 2021)
• View all prosthetic and orthotics fee schedules

Social Services

• Social services supplement (updated October 1, 2020)
• September 1, 2021 to present - Social services blanket codes
• November 17, 2020 to August 31, 2021 - Social services blanket codes
• View all social services blanket codes

Respiratory care

Billing guides

• August 1, 2022 to present - Respiratory care billing guide
• July 1, 2022 to July 31, 2022 - Respiratory care billing guide
• October 1, 2021 to June 30, 2022 — Respiratory care billing guide
• View all respiratory care billing guides

Fee schedules

• July 1, 2022 to present — Respiratory care fee schedule (updated July 25, 2022)
• October 1, 2021 to June 30, 2022 — Respiratory care fee schedule (published September 30, 2021)
• July 1, 2021 to September 30, 2021 — Respiratory care fee schedule (published July 8, 2021)
• View all respiratory care fee schedules

Social Services

• Social services supplement (updated October 1, 2020)
• September 1, 2021 to present - Social services blanket codes
• November 17, 2020 to August 31, 2021 - Social services blanket codes
• View all social services blanket codes

Rural health clinics (RHCs)

Billing guides

• August 1, 2022 to present - Rural health clinics billing guide
• July 1, 2022 to July 31, 2022 - Rural health clinics billing guide
• April 1, 2022 to June 30, 2022 - Rural health clinics billing guide
• View all RHC billing guides

Encounter rates

• July 1, 2022 to present — RHC encounter rates (updated August 15, 2022)
• April 1, 2022 to June 30, 2022 — RHC encounter rates (updated August 15, 2022)
• January 1, 2022 to March 31, 2022 — RHC encounter rates (updated April 19, 2022)
• View all RHC encounter rates

Enhancement rates

• July 1, 2022 to present — RHC enhancement rates (updated August 9, 2022)
• April 1, 2022 to June 30, 2022 — RHC enhancement rates (updated August 9, 2022)
• January 1, 2022 to March 31, 2022 — RHC enhancement rates (updated August 9, 2022)
• View all RHC enhancement rates

School-based health care services (SBHS)

Billing guides

• July 1, 2022 to present -- SBHS billing guide
• October 1, 2021 to June 30, 2022--SBHS billing guide
• October 1, 2020 to September 30, 2021 --SBHS billing guide
• View all SBHS billing guides

Fee schedules

• July 1, 2022 to present — SBHS fee schedule (published June 29, 2022)
• October 1, 2021 to June 30, 2022 — SBHS fee schedule (published November 8, 2021)
• July 1, 2021 to September 30, 2021 — SBHS fee schedule (published June 30, 2021)
• View all SBHS fee schedules

Sleep centers

Billing guides

• July 1, 2022 to present - Sleep centers billing guide
• October 1, 2020 to June 30, 2022 — Sleep centers billing guide
• January 1, 2020 to September 30, 2020 — Sleep centers billing guide
• View all sleep centers billing guides

Fee schedules

• July 1, 2022 to present — Sleep centers fee schedule (updated July 25, 2022)
• July 1, 2021 to June 30, 202 — Sleep centers fee schedule (updated November 4, 2021)
• July 1, 2020 to June 30, 2021 — Sleep centers fee schedule (published June 30, 2020)
• View all sleep centers fee schedules

Centers of Excellence

• Sleep study centers directory

Substance Use Disorder Program

Billing guides

• July 1, 2022 to present — Substance use disorder billing guide
  (Fee-for-service benefits provided outside of the BHO process)
• April 1, 2021 to June 30, 2022 — Substance use disorder billing guide
  (Fee-for-service benefits provided outside of the BHO process)
• January 1, 2021 to March 31, 2021 — Substance use disorder billing guide
  (Fee-for-service benefits provided outside of the BHO process)
• View all SUD (FFS outside BHO process) billing guides
• View all SUD (outpatient) billing guides

Fee schedules

• July 1, 2022 to present — Substance use disorder fee schedule (published June 29, 2022)

• October 1, 2021 to June 30, 2022 — Substance use disorder fee schedule (published September 30, 2021)

• January 1, 2021 to September 30, 2021 — Substance use disorder fee schedule (updated January 21, 2021)

• View all substance use disorder fee schedules

Telehealth

Telemedicine policy and billing

• August 1, 2022 to present – Apple Health (Medicaid) telemedicine policy and billing

Audio-only telemedicine

Physical health audio-only procedure codes

• August 1, 2022 to present (planned) - Apple Health (Medicaid) physical health audio-only procedure codes (Updated June 16, 2022)

Behavioral health audio-only procedure codes

• August 1, 2022 to present (planned) - Apple Health (Medicaid) audio-only behavioral health codes (updated August 4, 2022)

Telehealth services billing guide audio only supplement

• June 28, 2022 to July 31, 2022 - Telehealth services billing guide audio only supplement Refer to Telemedicine policy and billing

COVID-19 public health emergency policies

Clinical policy and billing for COVID-19

• August 1, 2022 to present - Apple Health (Medicaid) clinical policy and billing for COVID-19
• July 22, 2022 to July 31, 2022 - Apple Health (Medicaid) clinical policy and billing
• February 1, 2022 to July 21, 2022 - Apple Health (Medicaid) clinical policy and billing
• January 1, 2022 to January 31, 2022 - Apple Health (Medicaid) clinical policy and billing
• View all clinical policy and billing FAQs

Telemedicine/telehealth brief - Effective January 1, 2022 see Clinical policy and billing

• June 6, 2020 to December 31, 2021 - Apple Health (Medicaid) telemedicine/telehealth brief
• May 10, 2020 to June 6, 2020 - Apple Health (Medicaid) telemedicine/telehealth brief
• April 29, 2020 to May 9, 2020 - Apple Health (Medicaid) telemedicine/telehealth brief
• View all telemedicine/telehealth briefs

Behavioral health policy and billing

• August 1, 2022 to present - Apple Health (Medicaid) behavioral health policy and billing
• February 1, 2022 to July 31, 2022 - Apple Health (Medicaid) behavioral health policy and billing
• April 29, 2021 to January 31, 2022 - Apple Health (Medicaid) behavioral health policy and billing
• View all behavioral health policy and billing FAQs

ABA policy and billing

• July 22, 2022 to present - Apple Health (Medicaid) ABA policy and billing
• February 1, 2022 to July 21, 2022 - Apple Health (Medicaid) ABA policy and billing
• January 1, 2022 to January 31, 2022 - Apple Health (Medicaid) ABA policy and billing
• View all ABA policy and billing FAQs

FAQ for diabetes education providers

• July 22, 2022 to present - Apple Health (Medicaid) FAQ for diabetes education providers
• February 1, 2022 to July 21, 2022 - Apple Health (Medicaid) FAQ for diabetes education providers
• January 1, 2022 to January 31, 2022 - Apple Health (Medicaid) FAQ for diabetes education providers
• View all FAQs for diabetes education providers

Home health services billing and policy during COVID-19 pandemic

• May 3, 2020 to present - Apple Health (Medicaid) home health services billing and policy during COVID-19 pandemic
• November 20, 2020 to May 2, 2021 - Apple Health (Medicaid) home health services billing and policy during COVID-19 pandemic
• October 1, 2020 to November 19, 2020 - Apple Health (Medicaid) home health services billing and policy during COVID-19 pandemic
• View all home health services billing and policy FAQs

Telehealth requirements for physical, occupational and speech therapy

• July 22, 2022 to present - Telehealth requirements for physical, occupational and speech therapy
• February 1, 2022 to July 21, 2022 - Telehealth requirements for physical, occupational and speech therapy
• January 1, 2022 to January 31, 2022 - Telehealth requirements for physical, occupational and speech therapy
• View all telehealth requirements for physical, occupational, and speech therapy

Telehealth services in long term care facilities and skilled nursing facilities

• January 1, 2022 to present - Telehealth services in long term care facilities and skilled nursing facilities
• May 3, 2021 to December 31, 2021 - Telehealth services in long term care facilities and skilled nursing facilities
• October 1, 2020 to May 2, 2021 - Telehealth services in long term care facilities and skilled nursing facilities
• View all Telehealth requirements for LTC and SNF

Family planning only billing guide telemedicine/telehealth COVID-19

• February 1, 2022 to present - Family planning only billing guide telemedicine/telehealth
• January 1, 2022 to January 31, 2022 - Family planning only billing guide telemedicine/telehealth
• May 3, 2021 to December 31, 2021 - Family planning only billing guide telemedicine/telehealth
• View all FPO Telehealth documents

School-based health care services (SBHS) COVID-19 billing FAQ

• July 1, 2022 to present – School-based health care services (SBHS) COVID-19 billing FAQ
• August 16, 2021 to June 30, 2022 – School-based health care services (SBHS) COVID-19 billing FAQ
• April 21, 2021 to August 15, 2021 – School-based health care services (SBHS) COVID-19 billing FAQ
• View all SBHS COVID-19 billing FAQs

Tribal Health Program

Billing guides

• July 1, 2022 to present - Tribal health billing guide
• January 1, 2022 to June 30, 2022 - Tribal health billing guide
• November 1, 2021 to December 31, 2021 — Tribal health billing guide
• View all Tribal Health Program billing guides

Fee schedules

• January 1, 2022 to present — Tribal health program fee schedule (published April 13, 2022)
• October 1, 2021 to December 31, 2021 — Tribal health program fee schedule (published January 24, 2022)
• January 1, 2021 to September 30, 2021 — Tribal health program fee schedule (published January 5, 2021)
• View all tribal health fee schedules