May 10, 2018

State of Alabama
Press Release: Medicaid

New Procedures Added to All-Inclusive Encounter Rate

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TO:  IRHC Providers 

Effective May 16, 2018, Medicaid will enforce Alabama Medicaid Administrative Code RuleNo. 560-X-8-.03 Reimbursement.  As a result, the following procedure codes may no longer be billed and paid outside the IRHC provider encounter rate. Providers should continue listing these procedure codes when filing claims for reimbursement.



·         99173 VISUAL ACUITY SCREEN


·         96127 BRIEF EMOTIONAL OR BEHAVIORAL ASSESSMENT (smoking cessation)


Claims that are billed using the non-IRHC number for reimbursement will be monitored on a post payment review process. Claims that are filed and paid with these procedures outside of the encounter rate will be subject to recoupment.


Contact the Provider Assistance Center at 1-800-688-7989 if you have received denials for the four codes listed above when billing and using the non-IRHC number.  A call center associate will review your file and advise you on how to proceed with refiling the claim.


Any other questions should be directed to Calvin Binion at

The Current Procedural Terminology (CPT) and Current Dental Terminology (CDT) codes descriptors, and other data are copyright © 2018 American Medical Association and © 2018 American Dental Association (or such other date publication of CPT and CDT). All rights reserved. Applicable FARS/DFARS apply.

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