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 1, 2025: (a) Assistive Care Services Fee Schedule https://www.flrules.org/Gateway/reference.asp?No=Ref-18271. (b) Behavior Analysis Fee Schedule https://www.flrules.org/Gateway/reference.asp?No=Ref-18300. (c) Behavioral Health Overlay Services Fee Schedule https://www.flrules.org/Gateway/reference.asp?No=Ref-18352. (d) Birth Center Fee Schedule https://www.flrules.org/Gateway/reference.asp?No=Ref-18302. (e) Community-Based Substance Abuse County Match Fee Schedule https://www.flrules.org/Gateway/reference.asp?No=Ref-18304. (f) Community Behavioral Health Services Fee Schedule https://www.flrules.org/Gateway/reference.asp?No=Ref-18364. (g) County Health Department Certified Match Program Fee Schedule https://www.flrules.org/Gateway/reference.asp?No=Ref-18305. (h) Dental General Fee Schedule https://www.flrules.org/Gateway/reference.asp?No=Ref-18306. (i) Durable Medical Equipment and Medical Supply Services Provider Fee Schedule for All Medicaid Recipients https://www.flrules.org/Gateway/reference.asp?No=Ref-18307. (j) Early Intervention Services Fee Schedule https://www.flrules.org/Gateway/reference.asp?No=Ref-18308. (k) Family Home Health Aide Services Fee Schedule https://www.flrules.org/Gateway/reference.asp?No=Ref-18309. (l) Hearing Services Fee Schedule https://www.flrules.org/Gateway/reference.asp?No=Ref-18310. (m) Home Health Visit Services Fee Schedule https://www.flrules.org/Gateway/reference.asp?No=Ref-18311. (n) Licensed Midwife Fee Schedule https://www.flrules.org/Gateway/reference.asp?No=Ref-18313. (o) Medicaid Certified School Match Program Fee Schedule https://www.flrules.org/Gateway/reference.asp?No=Ref-18314. (p) Medical Foster Care Services Fee Schedule https://www.flrules.org/Gateway/reference.asp?No=Ref-18315. (q) Occupational Therapy Services Fee Schedule https://www.flrules.org/Gateway/reference.asp?No=Ref-18354. (r) Personal Care Services Fee Schedule https://www.flrules.org/Gateway/reference.asp?No=Ref-18317. (s) Physical Therapy Fee Schedule https://www.flrules.org/Gateway/reference.asp?No=Ref-18365. (t) Physician Pediatric Surgery Fee Schedule https://www.flrules.org/Gateway/reference.asp?No=Ref-18319. (u) Prescribed Drugs Immunization Fee Schedule https://www.flrules.org/Gateway/reference.asp?No=Ref-18322. (v) Private Duty Nursing Services Fee Schedule https://www.flrules.org/Gateway/reference.asp?No=Ref-18324. (w) Radiology Fee Schedule https://www.flrules.org/Gateway/reference.asp?No=Ref-18325. (x) Regional Perinatal Intensive Care Center (RPICC) Neonatal Services Fee Schedule https://www.flrules.org/Gateway/reference.asp?No=Ref-18326. (y) Regional Perinatal Intensive Care Center (RPICC) Obstetrical Services Fee Schedule https://www.flrules.org/Gateway/reference.asp?No=Ref-18327. (z) Respiratory Therapy Services Fee Schedule https://www.flrules.org/Gateway/reference.asp?No=Ref-18328. (aa) Speech-Language Pathology Services Fee Schedule https://www.flrules.org/Gateway/reference.asp?No=Ref-18362. (bb) Transportation Services Fee Schedule https://www.flrules.org/Gateway/reference.asp?No=Ref-18332. (cc) Visual Services Fee Schedule https://www.flrules.org/Gateway/reference.asp?No=Ref-18333. (4) Florida Medicaid Fee Schedules Effective July 1, 2025: (a) Independent Laboratory Fee Schedule https://flrules.org/Gateway/reference.asp?No=Ref-18822. (b) Practitioner Fee Schedule https://flrules.org/Gateway/reference.asp?No=Ref-18628. (c) Practitioner Laboratory Fee Schedule https://flrules.org/Gateway/reference.asp?No=Ref-18823. (d) Prescribed Pediatric Extended Care Services Fee Schedule https://flrules.org/Gateway/reference.asp?No=Ref-18630. (5) Florida Medicaid Fee Schedule Effective July 8, 2025: Specialized Therapeutic Services Fee Schedule https://flrules.org/Gateway/reference.asp?No=Ref-18631. (6) Florida Medicaid Fee Schedules Effective October 1, 2025: (a) Independent Laboratory Fee Schedule https://flrules.org/Gateway/reference.asp?No=Ref-18824. (b) Practitioner Fee Schedule https://flrules.org/Gateway/reference.asp?No=Ref-18935. (c) Practitioner Laboratory Fee Schedule https://flrules.org/Gateway/reference.asp?No=Ref-18825. (d) Targeted Case Management Services Fee Schedule https://flrules.org/Gateway/reference.asp?No=Ref-18820. (7) Florida Medicaid Billing Codes Effective January 1, 2025: (a) County Health Department Billing Codes https://www.flrules.org/Gateway/reference.asp?No=Ref-18334. (b) Federally Qualified Health Center Billing Codes https://www.flrules.org/Gateway/reference.asp?No=Ref-18335. (c) Hospice Services Billing Codes https://www.flrules.org/Gateway/reference.asp?No=Ref-18336. (d) Hospital Outpatient Services Billing Codes https://www.flrules.org/Gateway/reference.asp?No=Ref-18337. (e) Intermediate Care Facility for Individuals with Intellectual Disabilities Services Billing Codes https://www.flrules.org/Gateway/reference.asp?No=Ref-18338. (f) Nursing Facility Services Billing Codes https://www.flrules.org/Gateway/reference.asp?No=Ref-18358. (g) Rural Health Clinic Billing Codes https://www.flrules.org/Gateway/reference.asp?No=Ref-18341. (h) Statewide Inpatient Psychiatric Program Services Billing Codes https://www.flrules.org/Gateway/reference.asp?No=Ref-18359. (8) Florida Medicaid Billing Codes Effective July 1, 2025: Prescribed Drugs Physician Administered Billing Codes https://flrules.org/Gateway/reference.asp?No=Ref-18629