CurrentAlaska MedicaidPolicy N/A

CHP encounter-rate reimbursement and coverage indicators for select CPT/HCPCS codes

Governs reimbursement rates and coverage indicators for specified CPT procedure codes for Alaska Medicaid Tribal/Community Health settings (CHA I–IV and CHP) effective 7/1/2025–6/30/2026; affects Tribal Health Organizations, Community Health Aides (CHA I–IV), Behavioral Health Aides (BHA) and participating providers.

Policy Summary

PayerAlaska Medicaid

PolicyCHP encounter-rate reimbursement and coverage indicators for select CPT/HCPCS codes

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateJul 1, 2025

Next Review DateN/A

Key ActionReimbursement will follow the CHP encounter rate established annually by the Office of Rate Review and provided to Tribal Health Organizations.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

7/1/2025-6/30/2026coverage period

CHP encounter ratereimbursement methodology

Multiple (10060–96365 shown)codes shown (excerpt)

CHA I-IV, CHPcoverage matrix columns

~150+listed codes (excerpt)

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Coverage Matrix and Flags

Coverage matrix (partial list)

Coverage indicators for each CPT/HCPCS code are listed by Community Health Aide (CHA) level I–IV and CHP. An 'X' denotes coverage/eligibility in that column; a '.' denotes not covered for that column.

See table entries below for per-code CHA I–IV and CHP coverage flags (partial list shown).

Examples (procedural codes)

10060 — I&D ABSCESS SIMPLE/SINGLE. CHA I = .; CHA II = X; CHA III = X; CHA IV = X; CHP = X.
10061 — I&D ABSCESS COMP/MULTIPLE. CHA I = .; CHA II = X; CHA III = X; CHA IV = X; CHP = X.
10120 — INC & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE. CHA I = .; CHA II = X; CHA III = X; CHA IV = X; CHP = X.

Examples (laboratory/urine)

81001 — URINALYSIS AUTO W/SCOPE. CHA I = .; CHA II = .; CHA III = X; CHA IV = X; CHP = X.
81025 — URINE PREGNANCY TEST. CHA I = X; CHA II = X; CHA III = X; CHA IV = X; CHP = X.

Examples (evaluation & management / home visits)

99205 — CHA I = .; CHA II = .; CHA III = X; CHA IV = X; CHP = X.
99211 — OFF/OP EST MAY X REQ PHY/QHP. CHA I = X; CHA II = X; CHA III = X; CHA IV = X; CHP = X.
99344 — HOME/RES VST NEW MOD MDM 60. CHA I = .; CHA II = .; CHA III = X; CHA IV = X; CHP = X.

Examples of code-specific coverage flags

Per-code coverage indicators (examples below): each example shows the CHA I–IV and CHP flag for that code.

99202 — CHA I = X; CHA II = X; CHA III = X; CHA IV = X; CHP = X.

99204 — CHA I = .; CHA II = .; CHA III = X; CHA IV = X; CHP = X.

99344 — CHA I = .; CHA II = .; CHA III = X; CHA IV = X; CHP = X.

CPT / HCPCS Codes and Groups

Selected procedural CPT codes (partial)CPTCovered

10060	I&D ABSCESS SIMPLE/SINGLE
10061	I&D ABSCESS COMP/MULTIPLE
10120	INC & RMVL FB SUBQ TISS SMPL
10140	I&D HEMATOMA/SEROMA/FLUID COLLECTION
10160	PUNCTURE/ASPIRATION ABSCESS HEMATOMA/BULLA
11400	EXCISION TRUNK/EXTREMITY B9 + MARGIN 0.5 CM
11401	EXCISION TRUNK/EXTREMITY B9 + MARGIN 0.6-1.0 CM
11402	EXCISION TRUNK/EXTREMITY B9 + MARGIN 1.1-2.0 CM
11403	EXCISION TRUNK/EXTREMITY B9 + MARGIN 2.1-3.0 CM

Selected vaccine CPT codes (partial)CPTCovered

90585	Vaccine percutaneous
90626	Tick-borne encephalitis vaccine 0.25 mL IM
90627	Tick-borne encephalitis vaccine 0.5 mL IM
90632	HepA vaccine adult IM
90636	HepA/HepB vaccine adult IM
90649	4-valent HPV vaccine 3 dose IM
90651	9-valent HPV vaccine 2/3 dose IM
90653	IIV adjuvant vaccine IM
90656	IIV3 vaccine no preservative 0.5 mL IM
90694	Influenza vaccine, preservative free (where listed)

1–10 of 19

1/2

Selected respiratory and developmental testing codes (partial)CPTCovered

93005	Electrocardiogram tracing
94640	Airway inhalation treatment
94760	Measure blood oxygen level
94761	Measure blood oxygen level
96110	Developmental screen with score
96112	Developmental test by physician/QHP first hour
96113	Developmental test by physician/QHP each additional

Injectable drugs and infusion supplies (partial)HCPCSCovered

G0312	Immunization counseling by a physician (office)
G0313	Immunization counseling by a physician (office)
G0314	Immunization counseling by a physician (office)
G0315	Immunization counseling by a physician (office)
G0443	Brief alcohol misuse counseling
J0561	Penicillin G benzathine injection
J0696	Ceftriaxone sodium injection
J0885	Epoetin alfa, non-ESRD
J1050	Medroxyprogesterone acetate
J1438	Etanercept injection

1–10 of 17

1/2

Coverage indicator legendmixed

X	Covered for listed CHA levels and CHP
.	Not covered for listed CHA level
CHA I-IV	Coverage columns representing category/level; 'X' indicates covered in that column

Billing Guidance and Reimbursement Notes

Note

CHP Encounter-Rate Reimbursement

Reimbursement will follow the CHP (Community Health Program) encounter rate which is established by the Office of Rate Review (ORR) each calendar year and communicated to participating Tribal Health Organizations (THOs) with CHA and BHA partners. CPT codes and descriptions are © 2025 American Medical Association. Applicable FAR/DFARS apply. Coverage and rates are subject to change.

Billing Rule

Coverage Flags Only

This document lists codes with coverage flags for CHA and CHP for the effective period 7/1/2025 - 6/30/2026. Presence of an "X" indicates the code is covered under that program for the stated effective period. Absence of an "X" indicates no coverage flag is present. Providers should verify prior authorization or other utilization management requirements with the payer when applicable.

Effective period: 7/1/2025 - 6/30/2026
93005 — ELECTROCARDIOGRAM TRACING; CHA III = X; CHA IV = X; CHP = X; CHA I = (no flag); CHA II = (no flag)

Key Terms and Rate Definitions

CHP encounter rate

DefinitionCHP encounter rate = the Community Health Program encounter rate established annually by the Office of Rate Review (ORR) and used for reimbursement to Tribal Health Organizations with participating CHAs and BHAs.

ApplicabilityUsed to reimburse services listed in this policy for participating Tribal Health Organizations and Community Health Aides/Behavioral Health Aides.

Effective period notedPolicy effective 7/1/2025 - 6/30/2026; reimbursement follows the CHP rate published by ORR each calendar year.

CHA I–IV and CHP definitions

CHA I–IVCHA I, CHA II, CHA III and CHA IV denote Community Health Aide certification/levels I through IV used to indicate which CHA level may provide and bill for a listed service.

CHP meaning