Florida Regulations 59G-4.002: Provider Reimbursement Schedules and Billing Codes
Current as of: 2024 | Check for updates
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(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.
Rulemaking Authority 409.919 FS. Law Implemented 409.902, 409.905, 409.906, 409.907, 409.908, 409.912, 409.913 FS. History-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, 6-20-16, 6-22-17, 2-8-18, 5-7-18, 1-7-19, 7-17-19, 12-15-20, 9-29-21, 8-2-22, 12-31-23.
Terms Used In Florida Regulations 59G-4.002
- Contract: A legal written agreement that becomes binding when signed.
(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.
Rulemaking Authority 409.919 FS. Law Implemented 409.902, 409.905, 409.906, 409.907, 409.908, 409.912, 409.913 FS. History-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, 6-20-16, 6-22-17, 2-8-18, 5-7-18, 1-7-19, 7-17-19, 12-15-20, 9-29-21, 8-2-22, 12-31-23.