PDF Version
TO: Primary
Care Providers, ACHN Participating Providers and Other Eligible Providers
RE: Rate
Increases for ACHN Participation and Primary Care Bump
Effective October 1, 2025, the Alabama
Medicaid Agency (Medicaid) is implementing the following rate increases for certain
procedure codes for eligible providers.
·
ACHN
Participation Rates
|
CPT
Code
|
Short
Description
|
FY
2026 ACHN Rate
|
|
99211
|
OFF/OP EST MAY X REQ JU/QHP
|
$19.56
|
|
99212
|
OFFICE O/P EST SF 10MIN
|
$48.26
|
|
99213
|
OFFICE O/P EST LOW 20 MIN
|
$78.19
|
|
99214
|
OFFICE O/P EST MOD 30 MIN
|
$110.62
|
|
99215
|
OFFICE O/P EST HI 40 MIN
|
$155.91
|
·
Primary
Care “Bump” Rates
|
CPT
Code
|
Short
Description
|
FY
2026 Bump Rate
|
|
99231
|
SBSQ HOSP IP/OBS SF/LOW 25
|
$45.25
|
|
99232
|
SBSQ HOSP IP/OBS MODERATE 35
|
$72.25
|
|
99233
|
SBSQ HOSP IP/OBS HIGH 50
|
$108.72
|
|
99238
|
HOSP IP/OBS DSCHRG MGMT 30/<
|
$73.95
|
|
99239
|
HOSP IP/OBS DSCHRG MGMT >30
|
$104.52
|
|
99306
|
1ST NF CARE HIGH MDM 50
|
$167.02
|
|
99308
|
SBSQ NF CARE LOW MDM 20
|
$67.88
|
|
99309
|
SBSQ NF CARE MODERATE MDM 30
|
$98.32
|
|
99310
|
SBSQ NF CARE HIGH MDM 45
|
$140.41
|
|
99315
|
NF DSCHRG MGMT 30 MIN/LESS
|
$74.62
|
|
99316
|
NF DSCHRG MGMT 30 MIN+
|
$120.06
|
|
99350
|
HOME/RES VST EST HIGH MDM 60
|
$170.20
|
Providers should continue to visit www.medicaid.alabama.gov for up-to-date information related to
reimbursement policies and program updates. Providers with billing questions should contact the Gainwell Technologies Provider Assitance Center at (800) 688-7989.
The Current Procedural
Terminology (CPT) and Current Dental Terminology (CDT) codes descriptors, and
other data are copyright © 2025 American Medical Association and © 2025 American Dental Association (or such other date publication of CPT and
CDT). All rights reserved. Applicable FARS/DFARS apply.