Florida Medicaid Fee Schedule

No. A listed Florida Medicaid fee is not a coverage, authorization, or payment guarantee. Coverage, prior authorization and service limits are set in AHCA's Medicaid coverage policies, which are adopted by rule into the Florida Administrative Code.

• AHCA Medicaid Policy Library

Florida delivers Medicaid mainly through Statewide Medicaid Managed Care (SMMC) plans: CMS reports 89.3% of enrollees were in managed care in 2024. Plans negotiate their own rates with providers. The fee-for-service rates apply when Florida Medicaid pays a claim directly. Florida does not require plans to pay this schedule; instead, section 409.967, Florida Statutes, sets a plan performance standard when physician rates equal or exceed Medicare.

• CMS Medicaid managed care enrollment, 2024
• Section 409.967, F.S.

These are the July 2026 Florida Medicaid rates. A claim can pay a different amount because of the date of service, modifier, place of service, units billed, provider enrollment or taxonomy, bundling with another service, coverage policy, prior authorization, and claim edits.

Florida marks some codes "BR" (By Report): there is no preset fee, and the claim is priced from the documentation submitted. Amounts marked with an asterisk apply only to high-risk deliveries. A code may also be bundled into another service or priced on a different Florida Medicaid schedule. A missing rate does not mean the service is noncovered or pays $0.

• AHCA Rule 59G-4.002 fee schedules

Florida Medicaid publishes separate fee schedules by provider type alongside the Florida Medicaid Practitioner Fee Schedule, and its provider manual sets the coverage and billing rules.

• AHCA Rule 59G-4.002 fee schedules and billing codes (current)
• AHCA historical Medicaid reimbursement schedules
• Rule 59G-4.002, F.A.C. (adopted schedules and effective dates)
• AHCA Medicaid Policy Library (coverage policies)

Under its CMS-approved methodology, AHCA adopts Medicare's RVUs and applies a standard GPCI of 1 across all locales, so there is a single statewide fee; codes without Medicare RVUs are priced from the Florida Medicare contractor's local rates. Payment is the lesser of billed charges or the Medicaid maximum fee, and each fee schedule takes effect by incorporation in Rule 59G-4.002, F.A.C., usually on January 1 and July 1.

• CMS-approved Florida SPA 24-0002: Practitioner Reimbursement Methodology
• Rule 59G-4.002, F.A.C.

The Legislature funds stacked increases for recipients under 21: an extra 4% on top of the 4% FSI, 24% for 29 pediatric specialty types, 10.2% on E/M codes for 13 specialty types, and 7.3% for MDs and DOs. AHCA multiplies the base fee by each factor in turn, and 'the highest rate following the inclusion of all applicable fee schedule increases is reimbursed.'

• CMS-approved Florida SPA 24-0002: Practitioner Reimbursement Methodology

Physicians with the maternal fetal medicine specialty type (065) receive an enhanced fee over the FSI rate on every code on the Practitioner and Radiology fee schedules. The Legislature has also funded targeted increases for NICU/PICU services and for epidurals. Laboratory services cannot exceed Medicare's clinical lab rates, and independent laboratories are paid 10% less than practitioner labs.

• CMS-approved Florida SPA 24-0002: Practitioner Reimbursement Methodology

No. Plans negotiate rates with physicians. Section 409.967, F.S., rewards plans that pay at or above Medicare ('when physician payment rates equal or exceed Medicare rates for similar services'), and section 409.975 pays nonparticipating essential providers at the Medicaid rate, but physicians and other practitioners cannot be classified as essential providers.

• Section 409.967, F.S.
• Section 409.975, F.S.

KFF's 2024 Medicaid-to-Medicare fee index puts Florida's fee-for-service fees at 0.64 of Medicare for all services, 0.56 for primary care and 0.82 for obstetric care, below the national average of 0.75, with obstetric care the closest to Medicare.

• KFF: Medicaid-to-Medicare Fee Index

Anesthesia is paid as a base rate plus a time amount for each 15 minutes, and increments of time that do not total 15 minutes are rounded down. The 4% pediatric increase applies to anesthesia for children under 21, so the listed base amount is not the full payment.

• CMS-approved Florida SPA 24-0002: Practitioner Reimbursement Methodology