Reimbursement

POLICY:

General Criteria

The reimbursement information below is applicable to the fee-for-service delivery system.

Claim Type: Professional (837P/CMS-1500).

Billing Code, Modifier, and Billing Unit: Providers must report the most current and appropriate billing code(s), modifier(s), and billing unit(s) for the service rendered, in accordance with applicable federal and state regulations, including Rule 59G-4.002, F.A.C., when applicable.

Diagnosis Code: Providers must report the most current and appropriate diagnosis code to the highest level of specificity that supports medical necessity, as appropriate for this service.

Rate: For a schedule of rates, as incorporated by reference in Rule 59G-4.002, F.A.C., providers shall refer to the Agency for Health Care Administration (AHCA) website or the applicable payer's published fee schedule, as appropriate.