The purpose of the amendment to Rule 59G-4.002, Florida Administrative Code, (F.A.C.), is to update fee schedules and billing codes in the existing rule.

 

AGENCY FOR HEALTH CARE ADMINISTRATION

Medicaid

RULE NO.:RULE TITLE:

59G-4.002Provider Reimbursement Schedules and Billing Codes

PURPOSE AND EFFECT: The purpose of the amendment to Rule 59G-4.002, Florida Administrative Code, (F.A.C.), is to update fee schedules and billing codes in the existing rule.

SUMMARY: The rule incorporates the 2021 Florida Medicaid fee schedules and billing codes by reference.

SUMMARY OF STATEMENT OF ESTIMATED REGULATORY COSTS AND LEGISLATIVE RATIFICATION:

The Agency has determined that this will not have an adverse impact on small business or likely increase directly or indirectly regulatory costs in excess of $200,000 in the aggregate within one year after the implementation of the rule. A SERC has not been prepared by the Agency.

The Agency has determined that the proposed rule is not expected to require legislative ratification based on the statement of estimated regulatory costs or if no SERC is required, the information expressly relied upon and described herein: A checklist was prepared by the Agency to determine the need for a SERC. Based on this information at the time of the analysis and pursuant to section 120.541, Florida Statutes, the rule will not require legislative ratification.

Any person who wishes to provide information regarding a statement of estimated regulatory costs, or provide a proposal for a lower cost regulatory alternative must do so in writing within 21 days of this notice.

RULEMAKING AUTHORITY: 409.919 FS.

LAW IMPLEMENTED: 409.902, 409.905, 409.906, 409.907, 409.908, 409.912, 409.913 FS.

A HEARING WILL BE HELD AT THE DATE, TIME AND PLACE SHOWN BELOW:

DATE AND TIME: August 10, 2021 from 3:00 p.m. to 3:30 p.m.

PLACE: The Agency is offering both a remote and an in-person option to attend the hearing at the Agency for Health Care Administration, 2727 Mahan Drive, Tallahassee, Florida 32308-5407.

Remote Listeners: Attendees may register for the hearing at: https://attendee.gotowebinar.com/register/5584032945572809229. After registering, a confirmation email will be received containing information about joining the webinar, and opportunities to offer comments and questions will be available.

Pursuant to the provisions of the Americans with Disabilities Act, any person requiring special accommodations to participate in this workshop/meeting is asked to advise the agency at least 7 days before the workshop/meeting by contacting: [e-mail]. If you are hearing or speech impaired, please contact the agency using the Florida Relay Service, 1(800)955-8771 (TDD) or 1(800)955-8770 (Voice).

THE PERSON TO BE CONTACTED REGARDING THE PROPOSED RULE IS: [e-mail]. Please note that a preliminary draft of the reference material, if available, will be posted prior to the hearing at http://ahca.myflorida.com/medicaid/review/fee_schedules.shtml. Official comments to be entered into the rule record will be received until 5:00 p.m., August 11, 2021. Comments may be e-mailed to [e-mail]. For general inquiries and questions about the rule, please contact [e-mail].

 

THE FULL TEXT OF THE PROPOSED RULE IS:

 

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 Web site at http://ahca.myflorida.com/Medicaid/review/index.shtml.

(3) Florida Medicaid Fee Schedules Effective January 1, 2021 2020:

(a) Ambulatory Surgical Center Services Fee Schedule

https://www.flrules.org/Gateway/reference.asp?No=Ref-_____12233.

(b) Assistive Care Services Fee Schedule

https://www.flrules.org/Gateway/reference.asp?No=Ref-______12234.

(c) Behavior Analysis Fee Schedule

https://www.flrules.org/Gateway/reference.asp?No=Ref-______12235.

(d) Behavioral Health Overlay Services Fee Schedule

https://www.flrules.org/Gateway/reference.asp?No=Ref-______12236.

(e) Birth Center Fee Schedule

https://www.flrules.org/Gateway/reference.asp?No=Ref-_______12237.

(f) Child Health Targeted Case Management Services Fee Schedule

https://www.flrules.org/Gateway/reference.asp?No=Ref-_______12238.

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

https://www.flrules.org/Gateway/reference.asp?No=Ref-_______12239.

(h) Community Behavioral Health Services Fee Schedule

https://www.flrules.org/Gateway/reference.asp?No=Ref-_______12240.

(i) County Health Department Certified Match Program Fee Schedule

https://www.flrules.org/Gateway/reference.asp?No=Ref-_______12241.

(j) Dental General Fee Schedule

https://www.flrules.org/Gateway/reference.asp?No=Ref-_______12242.

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

https://www.flrules.org/Gateway/reference.asp?No=Ref-______12243.

(l) Early Intervention Services Fee Schedule

https://www.flrules.org/Gateway/reference.asp?No=Ref-______12244.

(m) Hearing Services Fee Schedule

https://www.flrules.org/Gateway/reference.asp?No=Ref-______12245.

(n) Home Health Visit Services Fee Schedule

https://www.flrules.org/Gateway/reference.asp?No=Ref-______12246.

(o) Independent Laboratory Fee Schedule

https://www.flrules.org/Gateway/reference.asp?No=Ref-______12247.

(p) Licensed Midwife Fee Schedule

https://www.flrules.org/Gateway/reference.asp?No=Ref-______12248.

(q) Medicaid Certified School Match Program Fee Schedule

https://www.flrules.org/Gateway/reference.asp?No=Ref-______12249.

(r) Medical Foster Care Services Fee Schedule

https://www.flrules.org/Gateway/reference.asp?No=Ref-______12250.

(s) Mental Health Targeted Case Management Services Fee Schedule

https://www.flrules.org/Gateway/reference.asp?No=Ref-______12251.

(t) Occupational Therapy Services Fee Schedule

https://www.flrules.org/Gateway/reference.asp?No=Ref-______12252.

(u) Outpatient Laboratory Fee Schedule

https://www.flrules.org/Gateway/reference.asp?No=Ref-______12253.

(v) Personal Care Services Fee Schedule

https://www.flrules.org/Gateway/reference.asp?No=Ref-______12254.

(w) Physical Therapy Fee Schedule

https://www.flrules.org/Gateway/reference.asp?No=Ref-______12255.

(x) Physician Pediatric Surgery Fee Schedule

https://www.flrules.org/Gateway/reference.asp?No=Ref-______12256.

(y) Practitioner Fee Schedule

https://www.flrules.org/Gateway/reference.asp?No=Ref-______12257.

(z) Practitioner Laboratory Fee Schedule

https://www.flrules.org/Gateway/reference.asp?No=Ref-______12258.

(aa) Prescribed Drugs Immunization Fee Schedule

https://www.flrules.org/Gateway/reference.asp?No=Ref-______12259.

(bb) Prescribed Drugs Oncology Physician Administered Fee Schedule

https://www.flrules.org/Gateway/reference.asp?No=Ref-12260.

(cc) Prescribed Drugs Physcian Administered Fee Schedule

https://www.flrules.org/Gateway/reference.asp?No=Ref-12261.

(bb)(dd) Prescribed Pediatric Extended Care Services Fee Schedule

https://www.flrules.org/Gateway/reference.asp?No=Ref-______12262.

(cc)(ee) Private Duty Nursing Services Fee Schedule

https://www.flrules.org/Gateway/reference.asp?No=Ref-______12281.

(dd)(ff) Radiology Fee Schedule

https://www.flrules.org/Gateway/reference.asp?No=Ref-______12263.

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

https://www.flrules.org/Gateway/reference.asp?No=Ref-______12264.

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

https://www.flrules.org/Gateway/reference.asp?No=Ref-______12265.

(gg)(ii) Respiratory Therapy Fee Schedule

https://www.flrules.org/Gateway/reference.asp?No=Ref-______12266.

(hh)(jj) Specialized Therapeutic Services Fee Schedule

https://www.flrules.org/Gateway/reference.asp?No=Ref-______12267.

(ii)(kk) Speech-Language Pathology Services Fee Schedule

https://www.flrules.org/Gateway/reference.asp?No=Ref-______12268.

(jj)(ll) Targeted Case Management for Children at Risk of Abuse and Neglect Services Fee Schedule

https://www.flrules.org/Gateway/reference.asp?No=Ref-______12269.

(kk)(mm) Transportation Services Fee Schedule

https://www.flrules.org/Gateway/reference.asp?No=Ref-______12270.

(ll)(nn) Visual Services Fee Schedule

https://www.flrules.org/Gateway/reference.asp?No=Ref-______12271.

(4) Florida Medicaid Billing Codes Effective January 1, 2021 2020:

(a) County Health Department Billing Codes

https://www.flrules.org/Gateway/reference.asp?No=Ref-______12272.

(b) Federally Qualified Health Center Billing Codes

https://www.flrules.org/Gateway/reference.asp?No=Ref-______12273.

(c) Hospice Services Billing Codes

https://www.flrules.org/Gateway/reference.asp?No=Ref-_______12274.

(d) Hospital Outpatient Services Billing Codes

https://www.flrules.org/Gateway/reference.asp?No=Ref-______12275.

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

https://www.flrules.org/Gateway/reference.asp?No=Ref-______12276.

(f) Nursing Facility Services Billing Codes

https://www.flrules.org/Gateway/reference.asp?No=Ref-______12277.

(g) Rural Health Clinic Billing Codes

https://www.flrules.org/Gateway/reference.asp?No=Ref-______12278.

(h) Statewide Inpatient Psychiatric Program Services Billing Codes

https://www.flrules.org/Gateway/reference.asp?No=Ref-______12279.

(i)   Prescribed Drugs Physician Administered Billing Codes

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

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

The Agency will review this rule five years from the effective date and repromulgate, amend or repeal the rule as appropriate, in accordance with Section 120.54, F.S., and Chapter 1-1, F.A.C.

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,_____.

 

NAME OF PERSON ORIGINATING PROPOSED RULE: Jesse Bottcher

NAME OF AGENCY HEAD WHO APPROVED THE PROPOSED RULE: Simone Marstiller

DATE PROPOSED RULE APPROVED BY AGENCY HEAD: June 30, 2021

DATE NOTICE OF PROPOSED RULE DEVELOPMENT PUBLISHED IN FAR: April 19, 2021