1/day
One level-of-care per diem per day, IOP and PHP cannot both bill
Arizona SUD · AHCCCS · ASAM Criteria
ASAM levels of care to AHCCCS billing codes.
AHCCCS mandates the ASAM Criteria to place every substance use member at the right level of care. The catch that denies the claim: the level you document has to match the code you bill, per diem, per day, with the certification and diagnosis behind it. This is the crosswalk that keeps the two in sync.
0906
Revenue code paired with H0015 for IOP on the UB-04
CON
Certification of Need plus ASAM required before residential bills
414
The ACOM chapter that governs the SUD level-of-care assessment
The core ruleThe ASAM level you document is the claim you can bill.
AHCCCS does not let an Arizona substance use program pick a level of care by feel. It requires the ASAM Criteria, the national standard for matching a member to the least intensive setting that can safely treat them. The assessment produces a level: outpatient, intensive outpatient, partial hospitalization, one of the residential tiers, or withdrawal management. That level is not a clinical footnote. It is the thing the billed code has to agree with.
When the two disagree, the claim denies for medical necessity. A program that documents an ASAM 2.1 assessment and bills a residential per diem has a mismatch on its face. A program that runs a member at partial hospitalization intensity but only carries an outpatient determination in the chart has the same problem in reverse. The reviewer reads the level of care in the record, reads the code on the claim, and if they do not line up, the money comes back.
The ASAM determination has to be documented, current, and matched to the billed level. Everything else in this guide is downstream of that one sentence.
i
Read this before you bill. The codes and rules below are the real AHCCCS-recognized mappings, but policy and rates move. Verify every claim against live AHCCCS policy, including the AMPM, the Fee-For-Service Provider Billing Manual Chapter 19, and the Covered Behavioral Health Services Guide, plus the member's specific plan. This crosswalk orients you. The manuals govern you.
The signature visual
The ASAM continuum ladder.
Read it bottom to top, least intensive to most. Each rung is a level of care, its AHCCCS code, and the form it bills on. One rung per member per day.
ASAM assessment→
Level of care→
Matching code + POS→
F-series Dx→
Clean claim
The full crosswalkEvery ASAM level, mapped to its AHCCCS code.
The ladder is the map. The table is the reference you keep open while you build the claim. Read the level, confirm the code, confirm the per-diem or per-unit rule, and confirm the place of service before the claim goes out the door.
| ASAM level | Level of care | AHCCCS code(s) | Billing rule |
|---|---|---|---|
| 1.0 | Outpatient | H0004, H0005 | H0004 is individual behavioral health counseling, billed per 15 minutes. H0005 is group counseling. Time-based, not per diem. |
| 2.1 | Intensive outpatient (IOP) | H0015 | Per diem, once per day. Paired with revenue code 0906 on the UB-04. Cannot be billed on the same day as a PHP per diem. |
| 2.5 | Partial hospitalization (PHP) | H0035 (or S0201) | Per diem. One per day. Cannot be billed same day as an IOP per diem for the same member. |
| 3.1–3.5 | Residential (clinically managed) | H0018, H0019, H2036 | H0018 short-term residential per diem (prior authorization). H0019 long-term residential per diem for stays over 30 days. H2036 SUD residential per diem. Requires a Certification of Need (CON) plus the ASAM assessment under ACOM 414. |
| 3.7–WM | Withdrawal management / detox | H0008–H0014 | Per diem, by intensity of the withdrawal management setting. One level per day. |
| OTP | Opioid treatment (MAT, methadone-authorized) | G2067–G2075, H0020 | G2067–G2075 are weekly bundles that include counseling and toxicology. H0020 is methadone administration in an OTP, place of service 58. |
| OBOT | Office-based opioid treatment | G2086/G2087/G2088, J2315+96372, Q9991/Q9992 | G2086–G2088 are monthly office-based bundles. J2315 is Naltrexone XR, billed with 96372 for the injection. Q9991/Q9992 are Buprenorphine XR. |
!
The per-diem trap. Levels 2.1 and 2.5 are both per diem, and a member cannot bill both on the same day. If a program runs a member through IOP in the morning and PHP programming in the afternoon, only one per diem is payable, and it has to be the level the ASAM assessment supports. Two per diems on one date of service is a same-day duplicate denial waiting to happen.
Quick reference
Place-of-service codes for SUD claims.
11
Office
Office-based outpatient and OBOT services
55
Residential SUD
Residential substance abuse treatment facility
57
Non-residential SUD
Non-residential substance abuse treatment facility
58
OTP
Non-residential opioid treatment facility
F series
ICD-10 Dx
An F-series substance use diagnosis is required on every claim
The gate before residentialWhy residential needs a CON and an ASAM.
Residential is the level AHCCCS guards most tightly, because it is the most expensive and the most abused when placement is loose. A residential per diem does not pay on the ASAM level alone. It needs a Certification of Need, the CON, documenting that a lower level of care was considered and is not sufficient. It needs the ASAM assessment performed under the level-of-care rules in ACOM Chapter 414. Short-term residential under H0018 carries a prior authorization requirement. Long-term residential under H0019 is for stays that run past 30 days and comes with its own utilization scrutiny.
The pattern that denies is a residential claim with a thin chart behind it. The ASAM is stale, the CON is missing, or the assessment does not actually justify residential intensity over intensive outpatient. Build the residential file the way an auditor reads it: current ASAM, signed CON, prior authorization on file, and a narrative that names why a lower level of care will not hold.
Opioid treatmentOTP and OBOT are two different code families.
Medication for opioid use disorder splits into two lanes, and the codes do not cross. Opioid treatment programs, the methadone-authorized OTP setting, bill the weekly bundles G2067 through G2075. Those bundles are built to include counseling and toxicology, so the program does not unbundle a counseling code on top of the weekly bundle for the same services. Methadone administration inside the OTP is H0020, and it carries place of service 58.
Office-based opioid treatment is the other lane. OBOT bills the monthly bundles G2086, G2087, and G2088 out of an office setting, place of service 11. The long-acting injectables have their own codes: J2315 is Naltrexone XR, billed with 96372 for the administration, and Q9991 and Q9992 are the Buprenorphine XR formulations. Mixing an OTP weekly bundle with an OBOT monthly bundle for the same member in the same period is a structural error a reviewer catches fast.
Dx
Diagnosis is not optional. Every AHCCCS SUD claim needs an ICD-10 F-series substance use diagnosis to establish medical necessity. A per diem billed against a level of care with no supporting F-series diagnosis on the claim reads as clinically unjustified, and it denies the same way a level mismatch does.
What to hold onto
- The ASAM level in the chart and the level the code bills at have to match, or the claim denies for medical necessity.
- One level-of-care per diem per day. IOP (H0015) and PHP (H0035) cannot both bill on the same date of service.
- Residential needs a CON plus an ASAM under ACOM 414, and short-term residential needs prior authorization.
- OTP weekly bundles (G2067–G2075) already include counseling and toxicology. Do not unbundle on top of them.
- Place of service matters: 11 office, 55 residential, 57 non-residential SUD, 58 OTP. Wrong POS is a clean-claim edit.
- Every claim carries an F-series ICD-10 diagnosis. No exceptions.
Go deeper
Two resources that go with this crosswalk.
This blog gives you the map. The field guide gives you the full billing manual, and the denials piece shows you where Arizona SUD claims break in the real world.
Field guide
AHCCCS SUD billing and coding field guide
The full reference behind this crosswalk: level-of-care rules, per-diem mechanics, revenue codes, modifiers, and the AHCCCS policy citations that govern each. Read the field guide →
Denials
AHCCCS SUD billing mistakes and denials
Where Arizona SUD claims actually break: level mismatches, same-day per-diem duplicates, missing CON, stale ASAM, and the POS errors that trip clean-claim edits. See the denial patterns →
FAQ · AHCCCS SUD billing
Six questions Arizona SUD programs ask.
Can an IOP and a PHP be billed on the same day for one member?
No. Both H0015 (IOP) and H0035 (PHP) are level-of-care per diems, and AHCCCS pays one level-of-care per diem per member per day. If a member touches both levels of programming on one date of service, only the per diem that matches the ASAM-determined level is payable. Billing both on the same day produces a same-day duplicate denial.
Why did my residential claim deny even though the ASAM level was correct?
Residential is not authorized on the ASAM alone. It needs a Certification of Need (CON) documenting that a lower level of care is insufficient, and the ASAM has to be performed under ACOM Chapter 414. Short-term residential under H0018 also requires prior authorization. A correct ASAM level with a missing CON or missing prior auth still denies.
What revenue code goes with H0015 for IOP?
Revenue code 0906 on the UB-04, billed once per day. The H0015 HCPCS code carries the service and 0906 carries the revenue line. The pairing is what AHCCCS expects to see for an intensive outpatient per diem.
What is the difference between OTP and OBOT billing?
OTP is the methadone-authorized opioid treatment program setting, billing weekly bundles G2067 through G2075 that already include counseling and toxicology, plus H0020 for methadone administration at place of service 58. OBOT is office-based, billing the monthly bundles G2086 through G2088 at place of service 11, plus injectables like J2315 (Naltrexone XR) with 96372, and Q9991/Q9992 (Buprenorphine XR). The two families do not mix for the same member in the same period.
Which place-of-service code do I use for a residential SUD claim?
Place of service 55 for a residential substance abuse treatment facility. Use 57 for a non-residential SUD facility, 58 for a non-residential opioid treatment facility, and 11 for office-based services including OBOT. The wrong POS is a clean-claim edit that stops the claim before adjudication.
Do I really need an ICD-10 diagnosis on every SUD claim?
Yes. An F-series substance use diagnosis is required to establish medical necessity on every AHCCCS SUD claim. Without it, the per diem or the service reads as clinically unjustified and denies, even when the level of care and the code are otherwise correct.
Want your SUD claims cleaned up before AHCCCS does?
A no-cost review of a sample of your real Arizona SUD claims against the ASAM-to-code crosswalk, the per-diem rules, and the POS and diagnosis edits. Under a same-day BAA. The output names the mismatches, the same-day duplicates, and the missing certifications a coder can fix that week.