MEDICAID POLICY

(1) All Medicaid providers and their billing agents who submit claims on behalf of an enrolled Medicaid provider who are required by their service specific coverage and limitations handbook or other notification by the Medicaid Program to bill the Florida Medicaid Program on a pa…

(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 …

(1) All Medicaid providers and their billing agents who submit claims on behalf of an enrolled Medicaid provider, who are required by their service-specific coverage and limitations handbook or other notification by the Medicaid Program to bill the Florida Medicaid Program on a p…

Rulemaking Authority 409.919 FS. Law Implemented 409.905, 409.907, 409.908, 409.9081 FS. History-New 12-21-80, Formerly 10C-7.52, Amended 8-18-92, Formerly 10C-7.052, Amended 8-22-96, 3-11-98, 10-13-98, 6-8-99, 4-23-00, 8-5-01, 2-20-03, 8-5-03, 8-3-04, 8-18-05, Repealed 10-27-13.

(1) This rule applies to any person or entity prescribing or reviewing a request for allergy services and to all providers of allergy services who are enrolled in or registered with the Florida Medicaid program. (2) All persons or entities described in subsection (1), must be in …

(1) This rule applies to all providers rendering Florida Medicaid emergency transportation services to recipients. (2) All providers must be in compliance with the provisions of the Florida Medicaid Emergency Transportation Services Coverage Policy, October 2016, incorporated by …

(1) This rule applies to all providers rendering Florida Medicaid ambulatory surgical center services to recipients. (2) All providers must be in compliance with the provisions of the Florida Medicaid Ambulatory Surgical Center Services Coverage Policy, January 2019, incorporated…

(1) This rule applies to any person or entity prescribing or reviewing a request for anesthesia services and to all providers of anesthesia services who are enrolled in or registered with the Florida Medicaid program. (2) All persons or entities described in subsection (1), must …

(1) This rule applies to all providers rendering Florida Medicaid assistive care services to recipients. (2) All providers must comply with the provisions of the Florida Medicaid Assistive Care Services Coverage Policy, July 2017, incorporated by reference, and available on the A…

(1) This rule applies to any person or entity prescribing or reviewing a request for gastrointestinal practitioner services and to all providers of gastrointestinal practitioner services who are enrolled in or registered with the Florida Medicaid program. (2) All persons or entit…

(1) This rule applies to all providers of behavioral health overlay services who are enrolled in the Florida Medicaid program. (2) All providers of behavioral health overlay services must be in compliance with the provisions of the Florida Medicaid Behavioral Health Overlay Servi…

(1) This rule applies to all providers rendering Florida Medicaid behavioral health assessment services to recipients. (2) All providers must be in compliance with the provisions of the Florida Medicaid Behavioral Health Assessment Services Coverage Policy, November 2019, incorpo…

(1) This rule applies to all providers rendering Florida Medicaid behavioral health medication management services to recipients. (2) All providers must be in compliance with the provisions of the Florida Medicaid Behavioral Health Medication Management Services Coverage Policy, …

(1) This rule applies to all providers rendering Florida Medicaid reproductive services to recipients. (2) All providers must be in compliance with the provisions of the Florida Medicaid Reproductive Services Coverage Policy, July 2016, incorporated by reference. The policy is av…

(1) This rule applies to all providers rendering Florida Medicaid behavioral health community support services to recipients. (2) All providers must be in compliance with the provisions of the Florida Medicaid Behavioral Health Community Support Services Coverage Policy, November…

(1) This rule applies to any person or entity prescribing or reviewing a request for integumentary services and to all providers of integumentary services who are enrolled in or registered with the Florida Medicaid program. (2) All persons or entities described in subsection (1),…

(1) This rule applies to any person or entity prescribing or reviewing a request for cardiovascular services and to all providers of cardiovascular services who are enrolled in or registered with the Florida Medicaid program. (2) All persons or entities described in subsection (1…

(1) This rule applies to all school districts enrolled in the Medicaid certified school match program, as described in Section 409.9071, F.S. (2) All school district providers enrolled in Medicaid under the certified school match program must be in compliance with the Florida Med…

(1) This rule applies to all providers rendering Florida Medical chiropractic services to recipients. (2) All providers must be in compliance with the provisions of the Florida Medicaid Chiropractic Services Coverage Policy, January 2019, incorporated by reference. The policy is …

Rulemaking Authority 409.919 FS. Law Implemented 409.902, 409.906, 409.907, 409.908, 409.9081, 409.912, 409.913 FS. History-New 1-27-82, Amended 10-25-84, Formerly 10C-7.525, Amended 1-19-94, Formerly 10C-7.0525, Amended 9-21-98, 11-14-00, 1-19-05, 3-13-14, Repealed 12-22-19.

(1) This rule applies to all providers rendering Florida Medicaid behavioral health therapy services to recipients. (2) All providers must be in compliance with the provisions of the Florida Medicaid Behavioral Health Therapy Services Coverage Policy, November 2019, incorporated …

(1) This rule applies to all county health department clinic (CHD) providers that are in or registered with the Florida Medicaid program. (2) All CHD providers must comply with Title 42, Code of Federal Regulations, Parts 440 and 491. (3) Florida Medicaid reimburses CHD providers…

(1) This rule applies to providers rendering certified match services in county health departments to recipients. (2) All providers must be in compliance with the provisions of the Florida Medicaid County Health Department Certified Match Program Coverage Policy, January 2019, in…

(1) This rule applies to all providers rendering Florida Medicaid Dental Services. (2) All providers must be in compliance with the provisions of the Florida Medicaid Dental Services Coverage Policy, August 2018, incorporated by reference. The policy is available on the Agency fo…

Rulemaking Authority 409.919 FS. Law Implemented 409.902, 409.906, 409.907, 409.908, 409.912, 409.913 FS. History-New 8-26-92, Formerly 10C-7.070, Amended 5-23-94, 1-7-96, 3-4-99, 10-18-00, 4-30-01, 10-1-08, 9-28-10, Repealed 1-1-25.

Rulemaking Authority 409.919 FS. Law Implemented 409.902, 409.906, 409.907, 409.908, 409.912, 409.913 FS. History-New 5-7-07, Amended 5-8-08, 9-21-11, 6-4-12, 2-26-13, 12-2-13, 7-2-14, Repealed 6-20-16.

(1) This rule applies to all providers rendering Florida Medicaid durable medical equipment and medical supply services: specialized to recipients. (2) All providers must be in compliance with the provisions of the Florida Medicaid Durable Medical Equipment and Medical Supply Ser…

(1) This rule applies to all providers rendering Florida Medicaid durable medical equipment and medical supply services: orthotic and prosthetic to recipients. (2) All providers must be in compliance with the provisions of the Florida Medicaid Durable Medical Equipment and Medica…

(1) This rule applies to all providers rendering Florida Medicaid durable medical equipment and medical supply services: respiratory to recipients. (2) All providers must be in compliance with the provisions of the Florida Medicaid Durable Medical Equipment and Medical Supply Ser…

(1) This rule applies to all providers rendering Florida Medicaid durable medical equipment and medical supply services: wheelchairs, hospital beds, and ambulatory aids to recipients. (2) All providers must be in compliance with the provisions of the Florida Medicaid Durable Medi…

(1) This rule applies to all providers rendering Florida Medicaid durable medical equipment and medical supply services: continence, ostomy, and wound care to recipients. (2) All providers must be in compliance with the provisions of the Florida Medicaid Durable Medical Equipment…

(1) This rule applies to all providers rendering Florida Medicaid durable medical equipment and medical supply services: enteral and parenteral nutrition to recipients. (2) All providers must be in compliance with the provisions of the Florida Medicaid Durable Medical Equipment a…

Rulemaking Authority 409.919 FS., Chapter 92-129, Sec. 58, Laws of Florida. Law Implemented 409.905, 409.908 FS. History-New 1-1-77, Amended 2-6-78, 1-4-79, 2-18-80, 9-15-80, 9-30-81, Formerly 10C-7.47, Amended 7-17-91, 5-11-92, 5-27-93, Formerly 10C-7.047, Amended 12-26-95, 4-22…

(1) This rule applies to all providers rendering Florida Medicaid early intervention services to recipients. (2) All providers must be in compliance with the provisions of the Florida Medicaid Early Intervention Services Coverage Policy, October 2023, incorporated by reference. T…

(1) This rule applies to any person or entity prescribing or reviewing a request for evaluation and management services and to all providers of evaluation and management services who are enrolled in or registered with the Florida Medicaid program. (2) All persons or entities desc…

(1) This rule applies to all federally qualified health centers (FQHC) that are enrolled in or registered with the Florida Medicaid program. (2) All FQHCs must comply with Title 42, Code of Federal Regulations, Parts 440 and 491. (3) Florida Medicaid reimburses for services provi…

(1) This rule applies to all providers rendering Florida Medicaid dialysis services to recipients. (2) All providers of dialysis services must be in compliance with the provisions of the Florida Medicaid Dialysis Services Coverage Policy, June 2025, incorporated by reference. The…

Rulemaking Authority 409.919 FS. Law Implemented 409.906, 409.908 FS. History-New 7-29-09, Repealed 6-20-16.

(1) This rule applies to any person or entity prescribing or reviewing a request for genitourinary services and to all providers of genitourinary practitioner services who are enrolled in or registered with the Florida Medicaid program. (2) All persons or entities described in su…

(1) This rule applies to any person or entity prescribing or reviewing a request for hearing services and to all providers of hearing services who are enrolled in or registered with the Florida Medicaid program. (2) All persons or entities described in subsection (1), must be in …

(1) This rule applies to all providers of the Statewide Inpatient Psychiatric Program who are enrolled in or registered with the Florida Medicaid program. (2) All providers of the Statewide Inpatient Psychiatric Program must be in compliance with the provisions of the Florida Med…

(1) This rule applies to all providers rendering Florida Medicaid behavior analysis services to recipients. (2) All providers must be in compliance with the provisions of the Florida Medicaid Behavior Analysis Services Coverage Policy, December 2024, incorporated by reference. Th…

(1) This rule applies to all providers rendering Florida Medicaid Florida Assertive Community Treatment Services to recipients. (2) All providers must be in compliance with the provisions of the Florida Medicaid Florida Assertive Community Treatment Services Policy, December 2023…

(1) This rule applies to all providers rendering Florida Medicaid qualified residential treatment program services to recipients. (2) All providers must be in compliance with the provisions of the Florida Medicaid Qualified Residential Treatment Program Services Coverage Policy, …

(1) This rule applies to all providers rendering Florida Medicaid home health visit services to recipients. (2) All providers must be in compliance with the provisions of the Florida Medicaid Home Health Visit Services Coverage Policy, September 2024, incorporated by reference. T…

(1) This rule applies to providers enrolled directly in the Florida Medicaid program that furnish home health services (home health visits, private duty nursing, and personal care services) to recipients through the fee-for-service delivery system as specified on the Agency for H…

(1) This rule applies to all providers rendering Florida Medicaid hospice services to recipients. (2) All providers must be in compliance with the provisions of the Florida Medicaid Hospice Services Coverage Policy, December 2021, incorporated by reference. The policy is availabl…

(1) This rule applies to all providers rendering Florida Medicaid inpatient hospital services to recipients. (2) All providers must be in compliance with the provisions of the Florida Medicaid Inpatient Hospital Services Coverage Policy, March 2025, incorporated by reference.The …

(1) This rule applies to all providers rendering Florida Medicaid outpatient hospital services to recipients. (2) All providers must be in compliance with the provisions of the Florida Medicaid Outpatient Hospital Services Coverage Policy, August 2019, incorporated by reference. …

(1) This rule applies to all providers rendering Florida Medicaid intermediate care facility for individuals with intellectual disabilities services to recipients. (2) All providers must be in compliance with the provisions of the Florida Medicaid Intermediate Care Facility for I…