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Arizona Schedule of Benefits

2027
To read PDFs, you will need Adobe Acrobat Reader, You can download here.
2026
To read PDFs, you will need Adobe Acrobat Reader, You can download here.

When submitting a claim for a covered service, please submit a written request with the following information:

  • Date of service
  • Provider/office name
  • Diagnosis code
  • CPT/HCPCS/REV code
  • Provider NPI
  • Amount billed
  • Any applicable medical records

For your convenience, claim forms can be found here:

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