Arizona: Avoid claim denials for social determinants of health

Last modified: July 28, 2021

The Arizona Healthcare Cost Containment System (AHCCCS) has specific guidelines for listing social determinants of health (SDOH) codes on claims for Medicaid members.

Please follow these guidelines to help ensure you’re billing us correctly when including SDOH codes on claims:

• Social determinant ICD-10 diagnosis code(s) in code range Z55–Z65 cannot be listed as the primary ICD-10 diagnosis code(s)
  • These codes should only be used as secondary or tertiary diagnosis codes
• We’ll deny claims submitted to us with ICD-10 diagnosis codes Z55–Z65 listed as the primary diagnosis code(s)
  •  If this happens, you’ll need to submit a corrected claim

Learn more

For more information about coding and reporting guidelines, please see:

• AHCCCS Social Determinants of Health ICD-10 Code List  
• Centers for Medicare & Medicaid Services (CMS) ICD-10-CM Guidelines, pages 17–18:
  ICD-10-CM Official Guidelines for Coding and Reporting

Please note: Coding and reporting guidelines may be updated at any time.

Questions?

• Call Provider Services at 800-445-1638 for AHCCCS Complete Care (ACC) and Developmental Disabilities (DD)
• Call 800-293-3740 for Arizona Long-Term Care System (ALTCS) 

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