Last Updated: February 1, 2026 Source: Florida Agency for Health Care Administration (AHCA)
What Is the Florida Medicaid Fee Schedule?
The Florida Medicaid fee schedule lists the maximum pay rates for healthcare providers. These rates apply to services given to Medicaid members in Florida.
In 2026, new federal rules and state updates have changed many of these rates.
Quick Summary
- The fee schedule sets maximum provider pay rates.
- Pediatric care doctors may earn 106.3% of Medicare rates.
- Rates are managed by AHCA under Rule 59G-4.002.
- Most members are in Statewide Medicaid Managed Care (SMMC).
- New federal transparency rules take effect July 1, 2026.
- Providers can download 2026 schedules in Excel or PDF format.
How Does the 2026 Fee Schedule Work?
The Florida Medicaid fee schedule is a list of maximum reimbursement rates. Healthcare providers use it to know how much they can be paid.
The Florida Agency for Health Care Administration (AHCA) manages all rates under Rule 59G-4.002.
Who Sets the Rates?
AHCA sets the rates for fee-for-service (FFS) Medicaid. The federal government sets rules that Florida must follow. By July 1, 2026, Florida must publish all FFS rates online in a searchable format.
Fee-for-Service vs. Managed Care
Most Florida Medicaid members are in Statewide Medicaid Managed Care (SMMC). FFS rates serve as the lowest payment floor.
Managed care organizations (MCOs) may pay different rates based on their own provider contracts.
Want to know if you qualify for Florida Medicaid? Read our guide: Florida Medicaid Eligibility 2026
2026 Reimbursement Rates by Service Type
Florida publishes separate fee schedules for different medical services. Each schedule lists current rates in Excel and PDF formats.
Key 2026 Rate Categories
| Service Category | 2026 Status |
|---|---|
| Pediatric Primary Care (MPIP) | 106.3% of Medicare rate |
| Standard Physician Services | 30–40% below Medicare |
| Durable Medical Equipment (DME) | Updated 2026 Excel/PDF files available |
| Home Health & Hospice | New 2026 schedules released |
| Therapy & Lab Services | Updated for Occupational Therapy, Hearing, and Labs |
Primary Care and Office Visits
Standard Medicaid rates for office visits are flat across Florida. They do not change based on your location.
Standard 2026 Medicaid Rates:
- CPT 99212 (brief visit): $28.14
- CPT 99213 (15-minute visit): $34.29
- CPT 99214 (30-minute visit): $53.43
These rates apply to all Florida counties. However, if you qualify for MPIP, your payment jumps to 106.3% of Medicare. Medicare rates vary by geographic locality.
Vaccine Administration Codes
Pediatric vaccine administration pays fixed rates under MPIP. These amounts are set for 2026 and do not vary by locality.
2026 Vaccine Administration Rates:
- 90460 (first vaccine with counseling): $24.01
- 90461 (each additional component): $12.00
- 90471 (first immunization injection): $24.01
- 90472 (each additional injection): $12.00
- 90473 (first intranasal/oral): $24.01
- 90474 (each additional intranasal/oral): $12.00
Specialized Pediatric Services
New rules in 2026 streamline access to pediatric behavioral health. Starting January 30, 2026, many plans no longer require prior authorization for certain codes.
Prescribed Pediatric Extended Care (PPEC) Rates:
- T1025 (full-day services): $281.68 per day
- T1026 (partial-day services): $44.73 per hour
These rates help children with complex medical needs receive extended care outside hospitals.
Want to know if your income qualifies for Medicaid? Read our guide: Florida Medicaid Income Limits 2026
MMA Physician Incentive Program (MPIP) 2026
The MMA Physician Incentive Program pays qualifying pediatric doctors more than the standard Medicaid rate. For services between October 1, 2025 and September 30, 2026, eligible providers earn 106.3% of the 2026 Medicare rate.
Who Qualifies for MPIP?
To get the higher 106.3% rate, a provider must meet these rules:
- Be a board-certified pediatrician, family practitioner, or internal medicine doctor.
- Have at least 60% of Medicaid receipts from qualifying E&M codes.
- Complete attestation through the AHCA Portal or their contracted MCO.
MPIP Evaluation & Management (E&M) Codes
These codes cover office visits for patients under age 21:
| Code Type | CPT Codes |
|---|---|
| New Patient Office Visits | 99202, 99203, 99204, 99205 |
| Established Patient Office Visits | 99211, 99212, 99213, 99214, 99215 |
| Consultations | 99242, 99243, 99244, 99245 |
| Well-Child Visits – New Patient | 99381, 99382, 99383, 99384, 99385 |
| Well-Child Visits – Established | 99391, 99392, 99393, 99394, 99395 |
MPIP Vaccine Administration Rates (2026)
These fixed rates encourage childhood immunizations:
| CPT Code | Description | 2026 Rate |
|---|---|---|
| 90460 | Initial vaccine with counseling (through age 18) | $24.01 |
| +90461 | Each additional vaccine with counseling | $12.00 |
| 90471 | Initial immunization (IM, SubQ, ID, or percutaneous) | $24.01 |
| +90472 | Each additional immunization | $12.00 |
| 90473 | Initial intranasal or oral administration | $24.01 |
| +90474 | Each additional intranasal or oral administration | $12.00 |
Rates by Location: Miami vs. Rest of Florida
Medicaid rates and Medicare-linked rates differ by geographic area in some cases.
Standard Medicaid FFS Rates Are Flat Statewide
For standard Medicaid billing, the rate does not change by county. It is the same everywhere in Florida.
| CPT Code | Miami-Dade (Locality 04) | Rest of Florida (Locality 99) |
|---|---|---|
| 99213 | $34.29 | $34.29 |
| 99214 | $53.43 | $53.43 |
MPIP and Medicare-Linked Rates Vary by Location
If you qualify for MPIP, your pay is based on the Medicare rate for your area. Miami-Dade has higher rates due to higher living costs.
| CPT Code | Rest of FL (Locality 99) | Miami-Dade (Locality 04) | MPIP Difference |
|---|---|---|---|
| 99213 | ~$89–$92 | ~$96–$100 | Miami is ~$8–$12 more per visit |
| 99214 | ~$126–$129 | ~$135–$140 | Miami is ~$10–$15 more per visit |
These are estimated ranges based on 2026 Medicare conversion factors and historical GPCI data.
Key Locality Areas in Florida (2026)
| Locality | Counties Covered |
|---|---|
| Locality 03 | Broward, Palm Beach, and surrounding areas |
| Locality 04 | Miami-Dade and Monroe Counties |
| Locality 99 | Rest of Florida |
Want to compare Medicaid income limits across all states? Read our guide: Medicaid Income Limits by State 2026
Special 2026 Updates for Pediatric Services
Several pediatric service codes have new rules in 2026.
Prior Authorization Changes
Starting January 30, 2026, some pediatric codes no longer need prior authorization from many Florida plans (such as Sunshine Health):
- CPT 96160 and 96161 – Health risk assessments
- CPT 96112 and 96113 – Developmental testing and evaluation
Prescribed Pediatric Extended Care (PPEC) Rates
| Service Type | CPT Code | 2026 Rate |
|---|---|---|
| Full-Day PPEC | T1025 | $281.68 per day |
| Partial-Day PPEC | T1026 | $44.73 per hour |
How to Access Official 2026 Fee Schedules
Providers should download fee schedules directly from AHCA. The agency updates files throughout the year. Using old schedules causes claim denials and underpayment.
Downloading from AHCA Rule 59G-4.002
Visit the official AHCA website at ahca.myflorida.com. Navigate to the Medicaid section and find Rule 59G-4.002. This page hosts all current fee schedule files.
Available 2026 Downloads:
- Full Practitioner Fee Schedule (Excel and PDF)
- Dental Fee Schedule (Excel)
- Durable Medical Equipment (DME) Fee Schedule (Excel)
- Independent Laboratory Fee Schedule (Excel)
- Licensed Midwife Fee Schedule (Excel)
- Home Health and Hospice Fee Schedules
- Birth Center Fee Schedule
Each file includes effective dates. Check these dates before billing. Rates change quarterly for some services.
📌 Official Source: Florida AHCA – Medicaid Provider Reimbursement 📌 Official Source: CMS Medicare Fee Schedule Info
Important Rules and Exceptions
Medicare Alignment Formula
For codes without a direct Medicare match, Florida uses this formula:
Medicare Equivalent Rate = (Florida Medicaid Rate × 1.6667) − 2% sequestration adjustment
Telehealth in 2026
Telehealth remains a covered service in Florida Medicaid for 2026. However, telehealth pay may not always equal in-person visit pay. The rate depends on the specific Medicaid plan and service type.
4% Pediatric Rate Increase
Many base rates for children have a 4% increase applied in 2026. This applies to provider types 25, 26, 27, 28, 29, 30, 35, and 62.
Tips for Providers
Use Rate Modeling
Compare your top CPT codes against both the standard fee schedule and the 106.3% MPIP rate. Your actual revenue depends on your specific code mix.
Check Your Geographic Locality
Make sure you use the correct Medicare locality in the Excel files. Using the wrong locality could result in lower pay, especially for MPIP-eligible providers in Miami-Dade.
Stay Updated
Federal transparency rules require Florida to keep rates published online. Check the AHCA website regularly for new updates throughout 2026.
Looking for the full Medicaid fee schedule breakdown? Read our guide: Medicaid Fee Schedule 2026
Frequently Asked Questions (FAQ)
1. What is the Florida Medicaid fee schedule for 2026?
It is a list of maximum pay rates set by AHCA for healthcare providers. It covers all services given to Florida Medicaid members. Rates are updated yearly based on federal and state rules.
2. How much do pediatric doctors earn under MPIP in 2026?
Qualifying pediatric doctors earn 106.3% of the 2026 Medicare rate. This applies to specific E&M and vaccine codes for patients under age 21. Providers must attest eligibility through AHCA.
3. Are Medicaid rates different in Miami vs. the rest of Florida?
Standard Medicaid FFS rates are flat statewide. However, MPIP and Medicare-linked rates are higher in Miami-Dade due to geographic cost differences under the GPCI system.
4. Where can I download the 2026 Florida Medicaid fee schedule?
Visit the AHCA Rule 59G-4.002 page on the official Florida AHCA website. Files are available in both Excel and PDF formats for all service categories.
5. What changed for pediatric services in Florida Medicaid in 2026?
Prior authorization is no longer required for some pediatric codes. PPEC rates are now fixed at $281.68 per full day. A 4% pediatric rate increase also applies to many base rates.
6. How do I know if I qualify for the MPIP higher rate?
You must be a board-certified pediatrician, family practitioner, or internal medicine doctor. At least 60% of your Medicaid receipts must come from qualifying E&M codes. You must also attest through AHCA.
Sources:
- Florida Agency for Health Care Administration (AHCA) Rule 59G-4.002
- AHCA MPIP Model 2025-2026
- Centers for Medicare & Medicaid Services (CMS) transparency mandates
Last Updated: February 2026
