Fla. Admin. Code R. 59G-4.002

Current through Reg. 50, No. 090; May 7, 2024

Section 59G-4.002 - Provider Reimbursement Schedules and Billing Codes

(1) This rule applies to providers rendering Florida Medicaid services to recipients.

(2) Florida Medicaid reimburses for services rendered in the fee-for-service delivery system based on a fee schedule, cost report, or contract. The following fee schedules and billing codes are incorporated by reference and available on the Agency for Health Care Administration's website at http://ahca.myflorida.com/Medicaid/review/index.shtml.

(3) Florida Medicaid Fee Schedules Effective July 1, 2022:

(a) Assistive Care Services Fee Schedule

https://www.flrules.org/Gateway/reference.asp?No=Ref-16089.

(b) Behavior Analysis Fee Schedule

https://www.flrules.org/Gateway/reference.asp?No=Ref-14539.

(c) Behavioral Health Overlay Services Fee Schedule

https://www.flrules.org/Gateway/reference.asp?No=Ref-16090.

(d) Birth Center Fee Schedule

https://www.flrules.org/Gateway/reference.asp?No=Ref-16091.

(e) Community-Based Substance Abuse County Match Fee Schedule

https://www.flrules.org/Gateway/reference.asp?No=Ref-14543.

(f) Community Behavioral Health Services Fee Schedule

https://www.flrules.org/Gateway/reference.asp?No=Ref-16092.

(g) County Health Department Certified Match Program Fee Schedule

https://www.flrules.org/Gateway/reference.asp?No=Ref-14545.

(h) Dental General Fee Schedule

https://www.flrules.org/Gateway/reference.asp?No=Ref-16093.

(i) Durable Medical Equipment and Medical Supply Services Provider Fee Schedule for All Medicaid Recipients

https://www.flrules.org/Gateway/reference.asp?No=Ref-14547.

(j) Early Intervention Services Fee Schedule

https://www.flrules.org/Gateway/reference.asp?No=Ref-14548.

(k) Hearing Services Fee Schedule

https://www.flrules.org/Gateway/reference.asp?No=Ref-16094.

(l) Home Health Visit Services Fee Schedule

https://www.flrules.org/Gateway/reference.asp?No=Ref-16095.

(m) Independent Laboratory Fee Schedule

https://www.flrules.org/Gateway/reference.asp?No=Ref-16096.

(n) Licensed Midwife Fee Schedule

https://www.flrules.org/Gateway/reference.asp?No=Ref-16097.

(o) Medicaid Certified School Match Program Fee Schedule

https://www.flrules.org/Gateway/reference.asp?No=Ref-14553.

(p) Medical Foster Care Services Fee Schedule

https://www.flrules.org/Gateway/reference.asp?No=Ref-16098.

(q) Occupational Therapy Services Fee Schedule

https://www.flrules.org/Gateway/reference.asp?No=Ref-16099.

(r) Personal Care Services Fee Schedule

https://www.flrules.org/Gateway/reference.asp?No=Ref-16100.

(s) Physical Therapy Fee Schedule

https://www.flrules.org/Gateway/reference.asp?No=Ref-16101.

(t) Physician Pediatric Surgery Fee Schedule

https://www.flrules.org/Gateway/reference.asp?No=Ref-14559.

(u) Practitioner Fee Schedule

https://www.flrules.org/Gateway/reference.asp?No=Ref-16102.

(v) Practitioner Laboratory Fee Schedule

https://www.flrules.org/Gateway/reference.asp?No=Ref-16103.

(w) Prescribed Drugs Immunization Fee Schedule

https://www.flrules.org/Gateway/reference.asp?No=Ref-14562.

(x) Prescribed Pediatric Extended Care Services Fee Schedule

https://www.flrules.org/Gateway/reference.asp?No=Ref-16104.

(y) Private Duty Nursing Services Fee Schedule

https://www.flrules.org/Gateway/reference.asp?No=Ref-16105.

(z) Radiology Fee Schedule

https://www.flrules.org/Gateway/reference.asp?No=Ref-16106.

(aa) Regional Perinatal Intensive Care Center (RPICC) Neonatal Services Fee Schedule

https://www.flrules.org/Gateway/reference.asp?No=Ref-14566.

(bb) Regional Perinatal Intensive Care Center (RPICC) Obstetrical Services Fee Schedule

https://www.flrules.org/Gateway/reference.asp?No=Ref-14567.

(cc) Respiratory Therapy Fee Schedule

https://www.flrules.org/Gateway/reference.asp?No=Ref-16107.

(dd) Specialized Therapeutic Services Fee Schedule

https://www.flrules.org/Gateway/reference.asp?No=Ref-16108.

(ee) Speech-Language Pathology Services Fee Schedule

https://www.flrules.org/Gateway/reference.asp?No=Ref-16109.

(ff) Targeted Case Management Services Fee Schedule

https://www.flrules.org/Gateway/reference.asp?No=Ref-16110.

(gg) Transportation Services Fee Schedule

https://www.flrules.org/Gateway/reference.asp?No=Ref-16111.

(hh) Visual Services Fee Schedule

https://www.flrules.org/Gateway/reference.asp?No=Ref-16112.

(4) Florida Medicaid Fee Schedules Effective January 1, 2023:

(a) Assistive Care Services Fee Schedule

https://www.flrules.org/Gateway/reference.asp?No=Ref-16113.

(b) Behavior Analysis Fee Schedule

https://www.flrules.org/Gateway/reference.asp?No=Ref-16114.

(c) Behavioral Health Overlay Services Fee Schedule

https://www.flrules.org/Gateway/reference.asp?No=Ref-16115.

(d) Birth Center Fee Schedule

https://www.flrules.org/Gateway/reference.asp?No=Ref-16116.

(e) Community-Based Substance Abuse County Match Fee Schedule

https://www.flrules.org/Gateway/reference.asp?No=Ref-16117.

(f) Community Behavioral Health Services Fee Schedule

https://www.flrules.org/Gateway/reference.asp?No=Ref-16118.

(g) County Health Department Certified Match Program Fee Schedule

https://www.flrules.org/Gateway/reference.asp?No=Ref-16157.

(h) Dental General Fee Schedule

https://www.flrules.org/Gateway/reference.asp?No=Ref-16119.

(i) Durable Medical Equipment and Medical Supply Services Provider Fee Schedule for All Medicaid Recipients

https://www.flrules.org/Gateway/reference.asp?No=Ref-16120.

(j) Early Intervention Services Fee Schedule

https://www.flrules.org/Gateway/reference.asp?No=Ref-16121.

(k) Hearing Services Fee Schedule

https://www.flrules.org/Gateway/reference.asp?No=Ref-16122.

(l) Home Health Visit Services Fee Schedule

https://www.flrules.org/Gateway/reference.asp?No=Ref-16123.

(m) Independent Laboratory Fee Schedule

https://www.flrules.org/Gateway/reference.asp?No=Ref-16124.

(n) Licensed Midwife Fee Schedule

https://www.flrules.org/Gateway/reference.asp?No=Ref-16125.

(o) Medicaid Certified School Match Program Fee Schedule

https://www.flrules.org/Gateway/reference.asp?No=Ref-16126.

(p) Medical Foster Care Services Fee Schedule

https://www.flrules.org/Gateway/reference.asp?No=Ref-16127.

(q) Occupational Therapy Services Fee Schedule

https://www.flrules.org/Gateway/reference.asp?No=Ref-16128.

(r) Personal Care Services Fee Schedule

https://www.flrules.org/Gateway/reference.asp?No=Ref-16129.

(s) Physical Therapy Fee Schedule

https://www.flrules.org/Gateway/reference.asp?No=Ref-16130.

(t) Physician Pediatric Surgery Fee Schedule

https://www.flrules.org/Gateway/reference.asp?No=Ref-16131.

(u) Practitioner Fee Schedule

https://www.flrules.org/Gateway/reference.asp?No=Ref-16132.

(v) Practitioner Laboratory Fee Schedule

https://www.flrules.org/Gateway/reference.asp?No=Ref-16133.

(w) Prescribed Drugs Immunization Fee Schedule

https://www.flrules.org/Gateway/reference.asp?No=Ref-16134.

(x) Prescribed Pediatric Extended Care Services Fee Schedule

https://www.flrules.org/Gateway/reference.asp?No=Ref-16135.

(y) Private Duty Nursing Services Fee Schedule

https://www.flrules.org/Gateway/reference.asp?No=Ref-16136.

(z) Radiology Fee Schedule

https://www.flrules.org/Gateway/reference.asp?No=Ref-16137.

(aa) Regional Perinatal Intensive Care Center (RPICC) Neonatal Services Fee Schedule

https://www.flrules.org/Gateway/reference.asp?No=Ref-16138.

(bb) Regional Perinatal Intensive Care Center (RPICC) Obstetrical Services Fee Schedule

https://www.flrules.org/Gateway/reference.asp?No=Ref-16139.

(cc) Respiratory Therapy Services Fee Schedule

https://www.flrules.org/Gateway/reference.asp?No=Ref-16140.

(dd) Specialized Therapeutic Services Fee Schedule

https://www.flrules.org/Gateway/reference.asp?No=Ref-16141.

(ee) Speech-Language Pathology Services Fee Schedule

https://www.flrules.org/Gateway/reference.asp?No=Ref-16142.

(ff) Targeted Case Management Services Fee Schedule

https://www.flrules.org/Gateway/reference.asp?No=Ref-16143.

(gg) Transportation Services Fee Schedule

https://www.flrules.org/Gateway/reference.asp?No=Ref-16144.

(hh) Visual Services Fee Schedule

https://www.flrules.org/Gateway/reference.asp?No=Ref-16145.

(5) Florida Medicaid Billing Codes Effective January 1, 2023:

(a) County Health Department Billing Codes

https://www.flrules.org/Gateway/reference.asp?No=Ref-16147.

(b) Federally Qualified Health Center Billing Codes

https://www.flrules.org/Gateway/reference.asp?No=Ref-16148.

(c) Hospice Services Billing Codes

https://www.flrules.org/Gateway/reference.asp?No=Ref-16149.

(d) Hospital Outpatient Services Billing Codes

https://www.flrules.org/Gateway/reference.asp?No=Ref-16150.

(e) Intermediate Care Facility for Individuals with Intellectual Disabilities Services Billing Codes

https://www.flrules.org/Gateway/reference.asp?No=Ref-16151.

(f) Nursing Facility Services Billing Codes

https://www.flrules.org/Gateway/reference.asp?No=Ref-16152.

(g) Prescribed Drugs Physician Administered Billing Codes

https://www.flrules.org/Gateway/reference.asp?No=Ref-16153.

(h) Rural Health Clinic Billing Codes

https://www.flrules.org/Gateway/reference.asp?No=Ref-16154.

(i) Statewide Inpatient Psychiatric Program Services Billing Codes

https://www.flrules.org/Gateway/reference.asp?No=Ref-16155.

(6) This rule is in effect for five years from its effective date.

Fla. Admin. Code Ann. R. 59G-4.002

Rulemaking Authority 409.919 FS. Law Implemented 409.902, 409.905, 409.906, 409.907, 409.908, 409.912, 409.913 FS.

New 8-18-05, Amended 11-30-05, 4-16-06, 10-11-06, 3-27-07, 7-25-07, 9-29-08, 4-28-09, 2-11-10, 1-31-11, 7-16-13, 5-21-14, Amended by Florida Register Volume 42, Number 110, June 7, 2016 effective 6/20/2016, Amended by Florida Register Volume 43, Number 109, June 6, 2017 effective 6/22/2017, Amended by Florida Register Volume 44, Number 015, January 23, 2018 effective 2/8/2018, Amended by Florida Register Volume 44, Number 080, April 24, 2018 effective 5/7/2018, Amended by Florida Register Volume 44, Number 249, December 26, 2018 effective 1/7/2019, Amended by Florida Register Volume 45, Number 128, July 2, 2019 effective 7/17/2019, Amended by Florida Register Volume 46, Number 232, December 1, 2020 effective 12/15/2020, Amended by Florida Register Volume 47, Number 178, September 14, 2021 effective 9/29/2021, Amended by Florida Register Volume 48, Number 139, July 19, 2022 effective 8/2/2022, Amended by Florida Register Volume 49, Number 244, December 19, 2023 effective 12/31/2023.