eLaws | eCases | State of Arizona |
 Arizona Administrative Code (Last Updated: November 17, 2016)
 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 Septem- ber 30, 2014  

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    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 rev- enue code is present and all diag- noses 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

Historical Note

New Section made by final rulemaking at 11 A.A.R. 3231, effective October 1, 2005 (Supp. 05-3). Amended by exempt rulemaking at 17 A.A.R. 1707, effective Octo- ber 1, 2011 (Supp. 11-3). Amended by final rulemaking at 19 A.A.R. 2747, effective October 8, 2013 (Supp. 13-3). Amended by final rulemaking at 20 A.A.R. 1956, Sep- tember 6, 2014 (Supp. 14-3).