Medicaid Provider Reimbursement Schedules

 

AGENCY FOR HEALTH CARE ADMINISTRATION

Medicaid

RULE NO.:RULE TITLE:

59G-4.002Medicaid Provider Reimbursement Schedules

NOTICE OF CHANGE

Notice is hereby given that the following changes have been made to the proposed rule in accordance with subparagraph 120.54(3)(d)1., F.S., published in Vol. 42 No. 8, January 13, 2016 issue of the Florida Administrative Register.

The following changes have been made to the rule text.

 

59G-4.002Medicaid Provider Reimbursement Schedules

 

(1) This rule applies to all providers rendering of Florida Medicaid services to recipients who are enrolled in or registered with the Florida Medicaid program.

(2) Florida Medicaid reimburses reimbursement for services rendered in the fee-for-service delivery system is categorized based on a fee schedule, cost report, or contract. The billing codes in each fee schedule are applicable to Florida Medicaid’s fee-for-service and managed care delivery systems. However, the rates listed on the individual fee schedules only apply to services rendered through the fee-for-service delivery system, unless otherwise specified by law in Chapter 409, Florida Statutes (F.S.). The following fee schedules and billing codes are incorporated by reference and available on the Agency for Health Care Administration’s Web site at  http://ahca.myflorida.com/Medicaid/review/index.shtml, and at [DOS place holder Ref-_______]:

(3) Florida Medicaid services Ffee Sschedules:

(a) Effective July 1, 2016: Private Duty Nursing Services Fee Schedule

(b) Effective January 1, 2016:

1. Assistive Care Services Fee Schedule

2. Behavior Analysis Fee Schedule

3. Birth Center Fee Schedule

4. Community-Based Substance Abuse County Match Fee Schedule

5. Dental General Fee Schedule

6. Durable Medical Equipment and Medical Supply Services Provider Fee Schedule for All Medicaid Recipients

7. Durable Medical Equipment and Medical Supply Services Provider Fee Schedule for Medicaid Recipients Under the Age of 21 Years

8. Hearing Services Fee Schedule

9. Independent Laboratory Fee Schedule

10. Licensed Midwife Fee Schedule

11. Medicaid Certified School Match Program Fee Schedule

12. Occupational Therapy Services Fee Schedule

13. Physical Therapy Services Fee Schedule

14. Physician and Outpatient Laboratory Fee Schedule

15. Practitioner Fee Schedule

16. Radiology Fee Schedule

17. Speech Language Pathology Services Fee Schedule

18 . Visual Services Fee Schedule

(c) Effective September 1, 2015:

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

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

(d) Effective August 1, 2015: Immunization Fee Schedule

(a) Effective July 1, 2015:

1. Independent Laboratory Services Fee Schedule

2. Physician Laboratory Services Fee Schedule

(b) Effective May 1, 2015:

1. Physician Injectable Medications Oncology Medications Fee Schedule

2. Physician Injectable Medications Oncology Medications Fee Schedule

3. Traumatic Brain and Spinal Cord Injury Waiver Disposable Incontinence Medical Supplies Fee Schedule

(e)(c) Effective January 1, 2015:

1. No change.

2. Ambulance Transportation Services Fee Schedule

23. No change.

4. Assistive Care Services Fee Schedule

5. Behavioral Analysis Fee Schedule

36. No change.

7. Birthing Center Fee Schedule

8.through11. renumbered 4. through 7. No change.

12. Dental General Fee Schedule

813. No change.

14. Dialysis Services Fee Schedule

15. Durable Medical Equipment and Medical Supply Services Provider Fee Schedule for All Medicaid Recipients Fee Schedule

16. Durable Medical Equipment and Medical Supply Services Provider Fee Schedule for Medicaid Recipients Under the Age of 21 Years

917. No change.

10. Emergency Transportation Services Fee Schedule

18. Hearing Services Fee Schedule

1119. No change.

20. Hospice Services Fee Schedule

21. Licensed Midwife Fee Schedule

22. Medicaid Certified School Match Program Fee Schedule

23. through 24. renumbered 12. through 13. No change.

25. Occupational Therapy Services Fee Schedule

1426. Optometric Services Fee Schedule

1527. Dental Oral and Maxillofacial Surgery Fee Schedule

28. through 29. renumbered 16. through 17. No change.

30. Physical Therapy Services Fee Schedule

31. through 33. renumbered 18. through 20. No change.

34. Physician Lab Fee Schedule

35. through 36. renumbered 21. through 22. No change.

2337. Physician Radiology Services Fee Schedule

38. through 41. renumbered 24. through 28. No change.

42. Private Duty Nursing Services Fee Schedule

43. through 45. renumbered 28. through 30. No change.

46. Speech-Language Pathology Services Fee Schedule

3147. No change

48. Visual Services Fee Schedule

(4) Florida Medicaid Bbilling Ccodes., effective January 1, 2015:

(a) Effective January 1, 2016:

1. County Health Department Billing Codes

2. Federally Qualified Health Center Billing Codes

3. Hospice Physician Services Billing Codes

4. Hospice Services Billing Codes

5. Rural Health Clinic Billing Codes

(b) Effective January 1, 2015:

(a) Child Health Check-up Services

(b) County Health Department Services

1.(c) Dental General Services Billing Codes

(d) Federally Qualified Health Center and Rural Health Clinic Services

2.(e) Hospital Outpatient Services Billing Codes

3.(f) Intermediate Care Facility for Individuals with Intellectual Disabilities Services Billing Codes

(g) Non-Emergency Transportation Services

4.(h) Nursing Facility Services Billing Codes

5.(i) Statewide Inpatient Psychiatric Program Services Billing Codes

(5) The fee schedules and billing codes are available from the Florida Medicaid fiscal agent’s Web site at  http://portal.flmmis.com/flPublic, and available at [DOS place holder Ref-___, to be assigned at adoption].

The following changes have been made to the Advanced Registered Nurse Practitioner, Dental Injectables, Physician Assistant, and Podiatry Fee Schedules:

See Physician Injectable Fee Schedule for J code pricing, now reads: For J code rates, see the Injectable Medications Fee Schedule(s), incorporated by reference, and available at http://ahca.myflorida.com/Medicaid/review/index.shtml.

The following changes have been made to the County Health Department Certified Match Program Fee Schedule:

Procedure codes were updated to remove outdated dates and codes.

The following changes have been made to the Hospital Outpatient Services Billing Codes:

The first paragraph of the Revenue Codes section now reads: Codes from the National Uniform Billing Manual are used to indicate the various services provided during a hospitalization. For more clarification regarding how and when to use these codes, refer back to the National Billing Manual.

The following changes have been made to the Intermediate Care Facility for Individuals with Intellectual Disabilities Services Billing Codes:

Revenue code 0182 description now reads: Home leave days (Therapeutic leave days).