Developmental Disabilities Waiver Disposable Incontinence Medical Supplies Fee Schedule and Minimum Quality Standards
AGENCY FOR HEALTH CARE ADMINISTRATION
RULE NO.:RULE TITLE:
59G-13.086Developmental Disabilities Waiver Disposable Incontinence Medical Supplies Fee Schedule and Minimum Quality Standards
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. 41 No. 24, February 5, 2015 issue of the Florida Administrative Register.
(2) The fee schedule is available from the Medicaid fiscal agent’s Web site at http://portal.flmmis.com/flpublic www.mymedicaid-florida.com. Select Public Information for Providers, then Provider Support, and then Fee Schedules.
The following changes have been made to the Developmental Disabilities Individual Budgeting Waiver Disposable Incontinence Medical Supplies Fee Schedule: codes, modifiers, descriptions, units, fees, limits, and maximum limits (respectively) have been added under the section “Recipients Ages 21 Years and Older”:
CODE
MOD
DESCRIPTION
UNIT
FEE
($)
LIMIT
(unit)
MAXIMUM
LIMIT
($/year)
A4310
UC
INSERTION TRAY WITHOUT DRAINAGE BAG AND WITHOUT CATHETER(ACCESSORIES ONLY)
2
4.03
24 per year
96.72
A4314
UC
INSERTION TRAY WITH DRAINAGE BAG WITH INDWELLING CATHETER, FOLEY TYPE, TWO-WAY LATEX WITH COATING (TEFLON, SILICONE, SILICONE ELASTOMER, OR HYDROPHILIC, ETC.)
2
10.67
24 per year
A4315
UC
INSERTION TRAY WITH DRAINAGE BAG WITH INDWELLING CATHETER, FOLEY TYPE, TWO-WAY, ALL SILICONE
2
10.67
24 per year
A4316
UC
INSERTION TRAY WITH DRAINAGE BAG WITH INDWELLING CATHETER, FOLEY TYPE, THREE-WAY, FOR CONTINUOUS IRRIGATION
2
10.67
24 per year
A4320
UC
IRRIGATION TRAY WITH BULB OR PISTON SYRINGE, ANY PURPOSE
31
4.90
372 per year
1,822.80
A4322
UC
IRRIGATION TRAY WITH BULB OR PISTON SYRINGE, EACH
31
2.15
372 per year
799.80
A4326
UC
MALE EXTERNAL CATHETER SPECIALTY TYPE WITH INTEGRAL COLLECTION CHAMBER, EACH
31
8.34
372 per year
3,102.48
A4327
UC
FEMALE EXTERNAL URINARY COLLECTION DEVICE; METAL CUP, EACH
1
1 per year
A4328
UC
FEMALE EXTERNAL URINARY COLLECTION DEVICE; POUCH, EACH
2
5.00
24 per year
120.00
A4330
UC
PERIANAL FECAL COLLECTION POUCH WITH ADHESIVE, EACH
31
5.19
372 per year
1,930.68
A4335
UC
INCONTINENCE SUPPLY; MISCELLANEOUS
1
250.00
12 per year
3,000.00
A4338
UC
INDWELLING CATHETER; FOLEY TYPE, TWO-WAY LATEX WITH COATING (TEFLON, SILICONE, SILICONE ELASTOMER, OR HYDROPHILIC, ETC.), EACH
3
6.16
36 per year
221.76
A4340
UC
INDWELLING CATHETER; SPECIALTY TYPE (E.G., COUDE, MUSHROOM, WING, ETC.), EACH
3
6.69
36 per year
240.84
A4344
UC
INDWELLING CATHETER, FOLEY TYPE, TWO-WAY, ALL SILICONE, EACH
3
5.34
36 per year
192.24
A4346
UC
INDWELLING CATHETER; FOLEY TYPE, THREE WAY FOR CONTINUOUS IRRIGATION, EACH
3
8.73
36 per year
314.28
A4354
UC
INSERTION TRAY WITH DRAINAGE BAG BUT WITHOUT CATHETER
3
3.88
36 per year
139.68
A4355
UC
IRRIGATION TUBING SET FOR CONTINUOUS BLADDER IRRIGATION THROUGH A THREE-WAY INDWELLING FOLEY CATHETER, EACH
4
2.52
48 per year
120.96
A4356
UC
EXTERNAL URETHRAL CLAMP OR COMPRESSION DEVICE (NOT TO BE USED FOR CATHETER CLAMP), EACH
1
34.92
1 per year
34.92
A4554
UC
DISPOSABLE UNDERPADS, ALL SIZES, (E.G., CHUX'S)
150
0.34
1,800 per year
612.00
A5102
UC
BEDSIDE DRAINAGE BOTTLE WITH OR WITHOUT TUBING, RIGID OR
1
6.69
2 per year
13.38
A5105
UC
EXPANDABLE, EACH URINARY SUSPENSORY; WITH LEG BAG, WITH OR WITHOUT TUBE
1
14.40
2 per year
28.80
A5113
UC
LEG STRAP; LATEX, REPLACEMENT ONLY, PER SET
1
4.48
4 per year
17.92
A5114
UC
LEG STRAP; FOAM OR FABRIC, REPLACEMENT ONLY, PER SET
1
5.53
4 per year
22.12
A5126
UC
ADHESIVE OR NON-ADHESIVE; DISK OR FOAM PAD
20
0.63
240 per year
151.20
A5200
UC
PERCUTANEOUS CATHETER/TUBE ANCHORING DEVICE, ADHESIVE SKIN ATTACHMENT
3
8.62
3 per year
310.32
A technical change regarding the fiscal agent Web site changed from www.mymedicaid-florida.com to http://portal.flmmis.com/flpublic and the path is removed.
