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.

SUBJECT AREA TO BE ADDRESSED: Provider Reimbursement Schedules and Billing Codes.

An additional area to be addressed during the workshop will be the potential regulatory impact Rule 59G-4.002, Florida Administrative Code, will have as provided for under sections 120.54 and 120.541, Florida Statutes.

RULEMAKING AUTHORITY: 409.919 FS.

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

A RULE DEVELOPMENT WORKSHOP WILL BE HELD AT THE DATE, TIME AND PLACE SHOWN BELOW:

DATE AND TIME: January 14, 2019 from 10:30 a.m. to 11:00 a.m.

PLACE: Agency for Health Care Administration, 2727 Mahan Drive, Building 3, Tallahassee, Florida 32308-5407.

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: Jesse Bottcher. 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 DEVELOPMENT AND A COPY OF THE PRELIMINARY DRAFT, IF AVAILABLE, IS: Jesse Bottcher, Bureau of Medicaid Policy, 2727 Mahan Drive, Mail Stop 20, Tallahassee, Florida 32308-5407, telephone: [phone], e-mail: [e-mail].

Please note that a preliminary draft of the reference material, if available, will be posted prior to the workshop at http://ahca.myflorida.com/Medicaid/review/index.shtml. Official comments to be entered into the rule record will be received from the date of this notice until 5:00 p.m., January 15, 2019. Comments may be e-mailed to [e-mail]. For general inquiries and questions about the rule, please contact the person specified above.

 

THE PRELIMINARY TEXT OF THE PROPOSED RULE DEVELOPMENT 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 website at http://ahca.myflorida.com/Medicaid/review/index.shtml.

(3) Florida Medicaid Fee Schedules Effective January July 1, 2019 2018:

(a) Ambulatory Surgical Center Services Fee Schedule

https://www.flrules.org/Gateway/reference.asp?No=Ref-_______10139.

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

https://www.flrules.org/Gateway/reference.asp?No=Ref-10147 .

(c) Outpatient Laboratory Fee Schedule

https://www.flrules.org/Gateway/reference.asp?No=Ref-10140 .

(d) Practitioner Fee Schedule

https://www.flrules.org/Gateway/reference.asp?No=Ref-10141.

(e) Practitioner Laboratory Fee Schedule

https://www.flrules.org/Gateway/reference.asp?No=Ref-10142 .

(f) Prescribed Pediatric Extended Care Services Fee Schedule

https://www.flrules.org/Gateway/reference.asp?No=Ref-10143 .

(g) Birth Center Fee Schedule

https://www.flrules.org/Gateway/reference.asp?No=Ref-10144.

(h) Hospice Services Billing Codes

https://www.flrules.org/Gateway/reference.asp?No=Ref-10145 .

(i) Hospital Outpatient Services Billing Codes

https://www.flrules.org/Gateway/reference.asp?No=Ref- 0146 .

(4) Florida Medicaid Fee Schedules Effective January 1, 2018:

(b) (a) Assistive Care Services Fee Schedule

https://www.flrules.org/Gateway/reference.asp?No=Ref-________09185.

(c)(b) Behavior Analysis Fee Schedule

https://www.flrules.org/Gateway/reference.asp?No=Ref-_______09186.

(d)(c) Behavioral Health Overlay Services Fee Schedule

https://www.flrules.org/Gateway/reference.asp?No=Ref-________09187.

(d) Birth Center Fee Schedule

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

(e)(d) Child Health Targeted Case Management Services Fee Schedule

https://www.flrules.org/Gateway/reference.asp?No=Ref-________09189.

(f)(e) Community-Based Substance Abuse County Match Fee Schedule

https://www.flrules.org/Gateway/reference.asp?No=Ref-________09190.

(g)(f) Community Behavioral Health Services Fee Schedule

https://www.flrules.org/Gateway/reference.asp?No=Ref-________09191.

(h)(g) County Health Department Certified Match Program Fee Schedule

https://www.flrules.org/Gateway/reference.asp?No=Ref-________09192.

(i)(h) Dental General Fee Schedule

https://www.flrules.org/Gateway/reference.asp?No=Ref-________09193.

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

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

(k)(i) Early Intervention Services Fee Schedule

https://www.flrules.org/Gateway/reference.asp?No=Ref-________09195.

(j) Transportation Services Fee Schedule

https://www.flrules.org/Gateway/reference.asp?No=Ref-09196.

(l)(k) Hearing Services Fee Schedule

https://www.flrules.org/Gateway/reference.asp?No=Ref-________09197.

(m)(l) Home Health Visit Services Fee Schedule

https://www.flrules.org/Gateway/reference.asp?No=Ref-________09198.

(m) Immunization Fee Schedule

https://www.flrules.org/Gateway/reference.asp?No=Ref-09199.

(n) Independent Laboratory Fee Schedule

https://www.flrules.org/Gateway/reference.asp?No=Ref-________09200.

(o) Licensed Midwife Fee Schedule

https://www.flrules.org/Gateway/reference.asp?No=Ref-________09201.

(p) Medicaid Certified School Match Program Fee Schedule

https://www.flrules.org/Gateway/reference.asp?No=Ref-________09202.

(q) Medical Foster Care Services Fee Schedule

https://www.flrules.org/Gateway/reference.asp?No=Ref-________09203.

(r) Mental Health Targeted Case Management Services Fee Schedule

https://www.flrules.org/Gateway/reference.asp?No=Ref-________09204.

(s) Occupational Therapy Services Fee Schedule

https://www.flrules.org/Gateway/reference.asp?No=Ref-________09205.  

(t) Outpatient Laboratory Fee Schedule (Formerly titled Physician and Outpatient Laboratory Fee Schedule)  

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

(u)(t) Personal Care Services Fee Schedule

https://www.flrules.org/Gateway/reference.asp?No=Ref-________09207.

(v)(u) Physical Therapy Fee Schedule

https://www.flrules.org/Gateway/reference.asp?No=Ref-_________09208.

(w)(v) Physician Pediatric Surgery Fee Schedule

https://www.flrules.org/Gateway/reference.asp?No=Ref-_________09209.

(x) Practitioner Fee Schedule

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

(y) Practitioner Laboratory Fee Schedule (Formerly titled Physician and Outpatient Laboratory Fee Schedule)

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

(z) Prescribed Drugs Immunization Fee Schedule

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

(aa) Prescribed Drugs Oncology Physician Administered Fee Schedule

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

(bb) Prescribed Drugs Physcian Administered Fee Schedule

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

(cc) Prescribed Pediatric Extended Care Services Fee Schedule

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

(w) Prescribed Drug Fee Schedule (Not Reviewed by the Pharmaceutical and Therapeutic Committee)

https://www.flrules.org/Gateway/reference.asp?No=Ref-09212.

(dd)(x) Private Duty Nursing Services Fee Schedule

https://www.flrules.org/Gateway/reference.asp?No=Ref-________09214.

(ee)(y) Radiology Fee Schedule

https://www.flrules.org/Gateway/reference.asp?No=Ref-________09215.

(ff)(z) Regional Perinatal Intensive Care Center (RPICC) Neonatal Services Fee Schedule

https://www.flrules.org/Gateway/reference.asp?No=Ref-________09216.

(gg)(aa) Regional Perinatal Intensive Care Center (RPICC) Obstetrical Services Fee Schedule

https://www.flrules.org/Gateway/reference.asp?No=Ref-________09217.

(hh)(bb) Respiratory Therapy Fee Schedule

https://www.flrules.org/Gateway/reference.asp?No=Ref-________09218.

(ii)(cc) Specialized Therapeutic Services Fee Schedule

https://www.flrules.org/Gateway/reference.asp?No=Ref-________09219.

(jj)(dd) Speech-Language Pathology Services Fee Schedule

https://www.flrules.org/Gateway/reference.asp?No=Ref-________09220.

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

https://www.flrules.org/Gateway/reference.asp?No=Ref-________09221.

(ll) Transportation Services Fee Schedule

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

(mm)(ff) Visual Services Fee Schedule

https://www.flrules.org/Gateway/reference.asp?No=Ref-_______09222.

(5) Florida Medicaid Billing Codes Effective January 1, 2019 2018:

(a) County Health Department Billing Codes

https://www.flrules.org/Gateway/reference.asp?No=Ref-________09223.

(b) Federally Qualified Health Center Billing Codes

https://www.flrules.org/Gateway/reference.asp?No=Ref-________09224.

(c) Hospice Services Billing Codes

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

(d) Hospital Outpatient Services Billing Codes

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

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

https://www.flrules.org/Gateway/reference.asp?No=Ref-________09227.

(f)(d) Nursing Facility Services Billing Codes

https://www.flrules.org/Gateway/reference.asp?No=Ref-________09228.

(g)(e) Rural Health Clinic Billing Codes

https://www.flrules.org/Gateway/reference.asp?No=Ref-________09229.

(h)(f) Statewide Inpatient Psychiatric Program Services Billing Codes

https://www.flrules.org/Gateway/reference.asp?No=Ref-________09230.

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,_________.