State of Alabama

09/22/2025 | Press release | Distributed by Public on 09/22/2025 11:05

Rate Increases for ACHN Participation and Primary Care Bump

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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 © 20 25 American Medical Association and © 20 25 American Dental Association (or such other date publication of CPT and CDT). All rights reserved. Applicable FARS/DFARS apply.

State of Alabama published this content on September 22, 2025, and is solely responsible for the information contained herein. Distributed via Public Technologies (PUBT), unedited and unaltered, on September 22, 2025 at 17:05 UTC. If you believe the information included in the content is inaccurate or outdated and requires editing or removal, please contact us at [email protected]