The purpose of the amendment to Rule 59G-4.002 is to incorporate by reference the Florida Medicaid provider reimbursement schedules and billing codes. The amendment records effective dates for reimbursement schedules for certain Florida Medicaid ...

 

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 is to incorporate by reference the Florida Medicaid provider reimbursement schedules and billing codes. The amendment records effective dates for reimbursement schedules for certain Florida Medicaid services.

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: October 19, 2016 at 1:30 p.m. to 2:30 p.m.

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

Remote Listeners: Register to view the presentation at https://attendee.gotowebinar.com/register/734252043585729796. A call in number will be provided upon successful registration through which remote attendees may listen to the discussion via telephone.

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: Monique Johnson 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: Monique Johnson, Bureau of Medicaid Policy, 2727 Mahan Drive, Mail Stop 20, Tallahassee, Florida 32308-5407, telephone: [phone], email: [e-mail]

 

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.

(a) Effective August 1, 2016:

1. Behavior Analysis Fee Schedule

(https://www.flrules.org/Gateway/reference.asp?No=Ref-_____);

2. Birth Center Fee Schedule

(https://www.flrules.org/Gateway/reference.asp?No=Ref-_____);

3. Licensed Midwife Fee Schedule

(https://www.flrules.org/Gateway/reference.asp?No=Ref-_____);

4. Practitioner Fee Schedule

(https://www.flrules.org/Gateway/reference.asp?No=Ref-_____);

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

(https://www.flrules.org/Gateway/reference.asp?No=Ref-____06809);

(c) Effective May 1, 2016:

1. Injectable Medications Fee Schedule Non-Oncology

(https://www.flrules.org/Gateway/reference.asp?No=Ref-_____);

2. Injectable Medications Fee Schedule Oncology

(https://www.flrules.org/Gateway/reference.asp?No=Ref-_____);

(d) (b) Effective January 1, 2016:

1. Assistive Care Services Fee Schedule

(https://www.flrules.org/Gateway/reference.asp?No=Ref-06810);

2. Behavior Analysis Fee Schedule

(https://www.flrules.org/Gateway/reference.asp?No=Ref-06811);

3. Birth Center Fee Schedule

(https://www.flrules.org/Gateway/reference.asp?No=Ref-06812);

2. 4. Community-Based Substance Abuse County Match Fee Schedule

(https://www.flrules.org/Gateway/reference.asp?No=Ref-06813);

3. 5. Dental General Fee Schedule

(https://www.flrules.org/Gateway/reference.asp?No=Ref-06814);

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

(https://www.flrules.org/Gateway/reference.asp?No=Ref-06815);

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

(https://www.flrules.org/Gateway/reference.asp?No=Ref-06816);

6. 8. Hearing Services Fee Schedule

(https://www.flrules.org/Gateway/reference.asp?No=Ref-06817);

7. 9. Independent Laboratory Fee Schedule

(https://www.flrules.org/Gateway/reference.asp?No=Ref-06818);

10. Licensed Midwife Fee Schedule

(https://www.flrules.org/Gateway/reference.asp?No=Ref-06819);

8. 11. Medicaid Certified School Match Program Fee Schedule

(https://www.flrules.org/Gateway/reference.asp?No=Ref-06820);

9. 12. Occupational Therapy Services Fee Schedule

(https://www.flrules.org/Gateway/reference.asp?No=Ref-06821);

10. 13. Physical Therapy Services Fee Schedule

(https://www.flrules.org/Gateway/reference.asp?No=Ref-06822);

11. 14. Physician and Outpatient Laboratory Fee Schedule

(https://www.flrules.org/Gateway/reference.asp?No=Ref-06823);

15. Practitioner Fee Schedule

(https://www.flrules.org/Gateway/reference.asp?No=Ref-06824);

12. 16. Radiology Fee Schedule

(https://www.flrules.org/Gateway/reference.asp?No=______Ref-06825);

13. 17. Speech-Language Pathology Services Fee Schedule

(https://www.flrules.org/Gateway/reference.asp?No=Ref-06826);

14. 18. Visual Services Fee Schedule

(https://www.flrules.org/Gateway/reference.asp?No=Ref-06827);

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

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

(https://www.flrules.org/Gateway/reference.asp?No=Ref-06828);

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

(https://www.flrules.org/Gateway/reference.asp?No=Ref-06829);

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

(https://www.flrules.org/Gateway/reference.asp?No=Ref-06830);

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

1. Advanced Registered Nurse Practitioner Fee Schedule

(https://www.flrules.org/Gateway/reference.asp?No=Ref-06831);

2. Ambulatory Surgical Center Services Fee Schedule

(https://www.flrules.org/Gateway/reference.asp?No=Ref-06832);

3. Behavioral Health Overlay Services Fee Schedule

(https://www.flrules.org/Gateway/reference.asp?No=Ref-06833);

4. Child Health Services Targeted Case Management Services Fee Schedule

(https://www.flrules.org/Gateway/reference.asp?No=Ref-06834);

5. Chiropractic Fee Schedule

(https://www.flrules.org/Gateway/reference.asp?No=Ref-06835);

6. Community Behavioral Health Services Fee Schedule

(https://www.flrules.org/Gateway/reference.asp?No=Ref-06836);

7. County Health Department Certified Match Program Fee Schedule

(https://www.flrules.org/Gateway/reference.asp?No=Ref-06837);

8. Dental Injectables Fee Schedule

(https://www.flrules.org/Gateway/reference.asp?No=Ref-06838);

9. Early Intervention Services Fee Schedule

(https://www.flrules.org/Gateway/reference.asp?No=Ref-06839);

10. Emergency Transportation Services Fee Schedule

(https://www.flrules.org/Gateway/reference.asp?No=Ref-06840);

11. Home Health Visit Services Fee Schedule

(https://www.flrules.org/Gateway/reference.asp?No=Ref-06841);

12. Medical Foster Care Services Fee Schedule

(https://www.flrules.org/Gateway/reference.asp?No=Ref-06842);

13. Mental Health Targeted Case Management Services Fee Schedule

(https://www.flrules.org/Gateway/reference.asp?No=Ref-06843);

14. Optometric Services Fee Schedule

(https://www.flrules.org/Gateway/reference.asp?No=Ref-06844);

15. Dental Oral and Maxillofacial Surgery Fee Schedule

(https://www.flrules.org/Gateway/reference.asp?No=Ref-06845);

16. Outpatient Hospital Laboratory Fee Schedule

(https://www.flrules.org/Gateway/reference.asp?No=Ref-06846);

17. Personal Care Services Fee Schedule

(https://www.flrules.org/Gateway/reference.asp?No=Ref-06847);

18. Physician Anesthesia Fee Schedule

(https://www.flrules.org/Gateway/reference.asp?No=Ref-06848);

19. Physician Assistant Fee Schedule

(https://www.flrules.org/Gateway/reference.asp?No=Ref-06849);

20. Physician Evaluation and Management Fee Schedule

(https://www.flrules.org/Gateway/reference.asp?No=Ref-06850);

21. Physician Medical Services Fee Schedule

(https://www.flrules.org/Gateway/reference.asp?No=Ref-06851);

22. Physician Pediatric Surgery Fee Schedule

(https://www.flrules.org/Gateway/reference.asp?No=Ref-06852);

23. Physician Radiology Services Fee Schedule

(https://www.flrules.org/Gateway/reference.asp?No=Ref-06853);

24. Physician Surgical Fee Schedule

(https://www.flrules.org/Gateway/reference.asp?No=Ref-06854);

25. Podiatry Fee Schedule

(https://www.flrules.org/Gateway/reference.asp?No=Ref-06855);

26. Portable X-Ray Fee Schedule

(https://www.flrules.org/Gateway/reference.asp?No=Ref-06856);

27. Prescribed Pediatric Extended Care Services Fee Schedule

(https://www.flrules.org/Gateway/reference.asp?No=Ref-06857);

28. Registered Nurse First Assistant Fee Schedule

(https://www.flrules.org/Gateway/reference.asp?No=Ref-06858);

29. Respiratory Therapy Services Fee Schedule

(https://www.flrules.org/Gateway/reference.asp?No=Ref-06859);

30. Specialized Therapeutic Services Fee Schedule

(https://www.flrules.org/Gateway/reference.asp?No=Ref-06860);

31. Targeted Case Management for Children at Risk of Abuse and Neglect Services Fee Schedule

(https://www.flrules.org/Gateway/reference.asp?No=Ref-06861);

(4) Florida Medicaid Billing Codes.

(a) Effective January 1, 2016:

1. County Health Department Billing Codes

(https://www.flrules.org/Gateway/reference.asp?No=Ref-06862);

2. Federally Qualified Health Center Billing Codes

(https://www.flrules.org/Gateway/reference.asp?No=Ref-06863);

3. Hospice Physician Services Billing Codes

(https://www.flrules.org/Gateway/reference.asp?No=Ref-06864);

4. Hospice Services Billing Codes

(https://www.flrules.org/Gateway/reference.asp?No=Ref-06865);

5. Rural Health Clinic Billing Codes

(https://www.flrules.org/Gateway/reference.asp?No=Ref-06866);

(b) Effective January 1, 2015:

1. Dental General Services Billing Codes

(https://www.flrules.org/Gateway/reference.asp?No=Ref-06867);

2. Hospital Outpatient Services Billing Codes

(https://www.flrules.org/Gateway/reference.asp?No=Ref-06868);

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

(https://www.flrules.org/Gateway/reference.asp?No=Ref-06869);

4. Nursing Facility Services Billing Codes

(https://www.flrules.org/Gateway/reference.asp?No=Ref-06870);

5. Statewide Inpatient Psychiatric Program Services Billing Codes

(https://www.flrules.org/Gateway/reference.asp?No=Ref-06871).

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,                            .