Arizona AHCCCS physical therapy coverage: limits, who can bill and referrals
The short answerAHCCCS covers 15 PT visits per benefit year for adults 21 and older to restore a skill, plus 15 more to acquire a new skill. PT needs a PCP or attending physician order and is not covered as maintenance.
By Javier Alvarez · Updated · 1 min read
1 row: Medicaid (by state) · Arizona. Public policy, not the member's benefits.
Arizona AHCCCS
AHCCCS Medical Policy Manual 310-X (effective 10/01/25) · Arizona
| Visit limits | Adults 21 and older (Acute and ALTCS) get 15 outpatient PT visits per benefit year to restore a skill or level of function, and another 15 visits per benefit year to acquire a new skill or level of function. A visit is PT services received in one day. [1] |
|---|---|
| Referral | PT must be ordered by the member's PCP or attending physician and be part of the individualized plan, which the PCP, attending physician or nonphysician practitioner reviews at least every 62 days. [1] |
| Who can bill | PT must be provided by a qualified physical therapist or by a qualified individual under the physical therapist's supervision. Members at home or in an HCBS or institutional setting get PT through a Medicare-certified home health agency or an independent practice physical therapist. [1] |
| Also | Outpatient PT is not covered as a maintenance program. For members who also have Medicare, AHCCCS cost-sharing coverage follows ACOM Policy 201. Prior authorization requirements for fee-for-service are in AMPM Policy 820. [1] |
What Arizona AHCCCS's documents say
The table above has every field we found for Arizona AHCCCS, with numbered sources. In short:
- Visit limits. Adults 21 and older (Acute and ALTCS) get 15 outpatient PT visits per benefit year to restore a skill or level of function, and another 15 visits per benefit year to acquire a new skill or level of function. A visit is PT services received in one day.
- Who can bill. PT must be provided by a qualified physical therapist or by a qualified individual under the physical therapist's supervision. Members at home or in an HCBS or institutional setting get PT through a Medicare-certified home health agency or an independent practice physical therapist.
Check Arizona AHCCCS's claim against the row
Before the claim goes out, compare it with the row above: the evaluation code matches the complexity you documented, the timed codes fit the minutes, any prior authorization covers the visit, and the plan of care is signed when the payer asks for it. The physical therapy table compares Medicaid with every other payer we checked.