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
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 2020 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: September 22, 2020, 2:00 p.m. to 2:30 p.m.
PLACE: Remote Listeners: Attendees may register for the workshop at: https://attendee.gotowebinar.com/register/7312432232120311052. 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 48 hours before the workshop/meeting by contacting: MedicaidRuleComments@ahca.myflorida.com. 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: MedicaidRuleComments@ahca.myflorida.com.
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, 2020 2019:
(a) Ambulatory Surgical Center Services Fee Schedule
https://www.flrules.org/Gateway/reference.asp?No=Ref-_______10603.
(b) Assistive Care Services Fee Schedule
https://www.flrules.org/Gateway/reference.asp?No=Ref-_______10604.
(c) Behavior Analysis Fee Schedule
https://www.flrules.org/Gateway/reference.asp?No=Ref-_______.
(d)(c)Behavioral Health Overlay Services Fee Schedule
https://www.flrules.org/Gateway/reference.asp?No=Ref-_______10605.
(e)(d) Birth Center Fee Schedule
https://www.flrules.org/Gateway/reference.asp?No=Ref-_______10606.
(f)(e) Child Health Targeted Case Management Services Fee Schedule
https://www.flrules.org/Gateway/reference.asp?No=Ref-_______10607.
(g)(f) Community-Based Substance Abuse County Match Fee Schedule
https://www.flrules.org/Gateway/reference.asp?No=Ref-_______10608.
(h)(g) Community Behavioral Health Services Fee Schedule
https://www.flrules.org/Gateway/reference.asp?No=Ref-_______10609.
(i)(h) County Health Department Certified Match Program Fee Schedule
https://www.flrules.org/Gateway/reference.asp?No=Ref-_______10610.
(j)(i) Dental General Fee Schedule
https://www.flrules.org/Gateway/reference.asp?No=Ref-_______10611.
(k)(j) Durable Medical Equipment and Medical Supply Services Provider Fee Schedule for All Medicaid Recipients
https://www.flrules.org/Gateway/reference.asp?No=Ref-________10612.
(l)(k) Early Intervention Services Fee Schedule
https://www.flrules.org/Gateway/reference.asp?No=Ref-________10613.
(m)(l) Hearing Services Fee Schedule
https://www.flrules.org/Gateway/reference.asp?No=Ref-________10614.
(n)(m) Home Health Visit Services Fee Schedule
https://www.flrules.org/Gateway/reference.asp?No=Ref-_______10615.
(o)(n) Independent Laboratory Fee Schedule
https://www.flrules.org/Gateway/reference.asp?No=Ref-_______10616.
(p)(o) Licensed Midwife Fee Schedule
https://www.flrules.org/Gateway/reference.asp?No=Ref-_______10617.
(q)(p) Medicaid Certified School Match Program Fee Schedule
https://www.flrules.org/Gateway/reference.asp?No=Ref-_______10618.
(r)(q) Medical Foster Care Services Fee Schedule
https://www.flrules.org/Gateway/reference.asp?No=Ref-_______10619.
(s)(r) Mental Health Targeted Case Management Services Fee Schedule
https://www.flrules.org/Gateway/reference.asp?No=Ref-_______10620.
(t)(s) Occupational Therapy Services Fee Schedule
https://www.flrules.org/Gateway/reference.asp?No=Ref-_______10621.
(u)(t) Outpatient Laboratory Fee Schedule (Formerly titled Physician and Outpatient Laboratory Fee Schedule)
https://www.flrules.org/Gateway/reference.asp?No=Ref-_______10622.
(v)(u) Personal Care Services Fee Schedule
https://www.flrules.org/Gateway/reference.asp?No=Ref-_______10623.
(v) Physician Therapy Fee Schedule
https://www.flrules.org/Gateway/reference.asp?No=Ref-10624.
(w) Physical Therapy Fee Schedule
https://www.flrules.org/Gateway/reference.asp?No=Ref-_______10625.
(x) Physician Pediatric Surgery Fee Schedule
https://www.flrules.org/Gateway/reference.asp?No=Ref-_______ .
(y)(x) Practitioner Fee Schedule
https://www.flrules.org/Gateway/reference.asp?No=Ref-_______10626.
(z)(y) Practitioner Laboratory Fee Schedule (Formerly titled Physician and Outpatient Laboratory Fee Schedule)
https://www.flrules.org/Gateway/reference.asp?No=Ref-________10627.
(aa)(z) Prescribed Drugs Immunization Fee Schedule
https://www.flrules.org/Gateway/reference.asp?No=Ref-________10628.
(bb)(aa) Prescribed Drugs Oncology Physician Administered Fee Schedule
https://www.flrules.org/Gateway/reference.asp?No=Ref-________10629.
(cc)(bb) Prescribed Drugs Physcian Administered Fee Schedule
https://www.flrules.org/Gateway/reference.asp?No=Ref-________10630.
(dd)(cc) Prescribed Pediatric Extended Care Services Fee Schedule
https://www.flrules.org/Gateway/reference.asp?No=Ref-_______10631.
(ee)(dd) Private Duty Nursing Services Fee Schedule
https://www.flrules.org/Gateway/reference.asp?No=Ref-_______10632.
(ff)(ee) Radiology Fee Schedule
https://www.flrules.org/Gateway/reference.asp?No=Ref-_______10633.
(gg)(ff) Regional Perinatal Intensive Care Center (RPICC) Neonatal Services Fee Schedule
https://www.flrules.org/Gateway/reference.asp?No=Ref-_______10634.
(hh)(gg) Regional Perinatal Intensive Care Center (RPICC) Obstetrical Services Fee Schedule
https://www.flrules.org/Gateway/reference.asp?No=Ref-_______10635.
(ii)(hh) Respiratory Therapy Fee Schedule
https://www.flrules.org/Gateway/reference.asp?No=Ref-_______10636.
(jj)(ii) Specialized Therapeutic Services Fee Schedule
https://www.flrules.org/Gateway/reference.asp?No=Ref-_______10637.
(kk)(jj) Speech-Language Pathology Services Fee Schedule
https://www.flrules.org/Gateway/reference.asp?No=Ref-_______10638.
(ll)(kk) Targeted Case Management for Children at Risk of Abuse and Neglect Services Fee Schedule
https://www.flrules.org/Gateway/reference.asp?No=Ref-_______10639.
(mm)(ll) Transportation Services Fee Schedule
https://www.flrules.org/Gateway/reference.asp?No=Ref-_______10640.
(nn)(mm) Visual Services Fee Schedule
https://www.flrules.org/Gateway/reference.asp?No=Ref-_______10641.
(4) Florida Medicaid Fee Schedules Effective January 1, 2018
Behavior Analysis Fee Schedule
https://www.flrules.org/Gateway/reference.asp?No=Ref-09186.
(4)(5) Florida Medicaid Billing Codes Effective January 1, 2020 2019:
(a) County Health Department Billing Codes
https://www.flrules.org/Gateway/reference.asp?No=Ref-_______10642.
(b) Federally Qualified Health Center Billing Codes
https://www.flrules.org/Gateway/reference.asp?No=Ref-_______10643.
(c) Hospice Services Billing Codes
https://www.flrules.org/Gateway/reference.asp?No=Ref-_______10644.
(d) Hospital Outpatient Services Billing Codes
https://www.flrules.org/Gateway/reference.asp?No=Ref-_______10645.
(e) Intermediate Care Facility for Individuals with Intellectual Disabilities Services Billing Codes
https://www.flrules.org/Gateway/reference.asp?No=Ref-_______10646.
(f) Nursing Facility Services Billing Codes
https://www.flrules.org/Gateway/reference.asp?No=Ref-_______10647.
(g) Rural Health Clinic Billing Codes
https://www.flrules.org/Gateway/reference.asp?No=Ref-_______10648.
(h) Statewide Inpatient Psychiatric Program Services Billing Codes
https://www.flrules.org/Gateway/reference.asp?No=Ref-_______10649.
(5) This rule expires 5 years from it’s 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, 2-7-18,5-7-18,1-7-19,________.
NAME OF PERSON ORIGINATING PROPOSED RULE: Jesse Bottcher
NAME OF AGENCY HEAD WHO APPROVED THE PROPOSED RULE: Mary C. Mayhew
DATE PROPOSED RULE APPROVED BY AGENCY HEAD: August 19, 2020
DATE NOTICE OF PROPOSED RULE DEVELOPMENT PUBLISHED IN FAR: January 24, 2020
Document Information
- Comments Open:
- 8/28/2020
- Summary:
- The rule incorporates the 2020 Florida Medicaid fee schedules and billing codes by reference.
- Purpose:
- 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.
- Rulemaking Authority:
- 409.919 FS.
- Law:
- 409.902, 409.905, 409.906, 409.907, 409.908, 409.912, 409.913 FS.
- Contact:
- MedicaidRuleComments@ahca.myflorida.com.
- Related Rules: (1)
- 59G-4.002. Medicaid Provider Reimbursement Schedule