Last verified: August 24, 2026
The Florida Medicaid fee schedule is not one single rate sheet. Florida’s Agency for Health Care Administration (AHCA) publishes separate reimbursement schedules for different provider types and services, including practitioner, dental, durable medical equipment (DME), behavior analysis, therapy, PPEC, home health, laboratory, transportation, and other services.
The most important thing to understand is that the applicable Florida Medicaid rate depends on the service, CPT or HCPCS code, provider type, modifier, unit, effective date, and payment methodology.
For that reason, this guide is designed to help providers, medical billers, researchers, and other users find the correct 2026 Florida Medicaid reimbursement information without relying on an outdated or overly generalized rate.
Important: An AHCA fee-schedule amount should not automatically be treated as the amount every Medicaid provider will receive from every health plan. Florida Medicaid fee-for-service (FFS) schedules and managed-care contract rates are not necessarily identical.
Quick Answer
The official Florida Medicaid provider reimbursement schedules are published by the Florida Agency for Health Care Administration (AHCA) under Rule 59G-4.002, Provider Reimbursement Schedules and Billing Codes.
AHCA maintains different schedules for different services and updates them throughout the year.
As of August 24, 2026, the AHCA directory shows several important 2026 schedule updates, including:
| Schedule | Current effective date shown by AHCA |
|---|---|
| Practitioner | January 1, 2026 |
| Behavior Analysis | January 1, 2026 |
| Behavioral Health Overlay Services | January 1, 2026 |
| Home Health Visit Services | January 1, 2026 |
| Occupational Therapy | January 1, 2026 |
| Physical Therapy | January 1, 2026 |
| Speech-Language Pathology | January 1, 2026 |
| Dental General | July 1, 2026 |
| Durable Medical Equipment | July 1, 2026 |
| PPEC | July 1, 2026 |
| Family Home Health Aide | July 2, 2026 |
Because AHCA can replace or update schedules during the year, always confirm the current effective date and official file before using a rate for billing or reimbursement analysis.
What Is the Florida Medicaid Fee Schedule?
The Florida Medicaid fee schedule is a collection of official reimbursement schedules used to establish or describe payment amounts and billing information for covered Medicaid services.
Rather than placing every service in one file, AHCA separates schedules by provider and service category.
For example, a provider may need a:
- Practitioner Fee Schedule
- Dental Fee Schedule
- DME Fee Schedule
- Behavior Analysis Fee Schedule
- Physical Therapy Fee Schedule
- Occupational Therapy Fee Schedule
- Speech-Language Pathology Fee Schedule
- PPEC Fee Schedule
- Home Health Fee Schedule
- Laboratory Fee Schedule
- Transportation Fee Schedule
This means the phrase “Florida Medicaid fee schedule” is broad. The correct schedule depends on what service you are billing.
AHCA’s Rule 59G-4.002 page is the primary directory for these schedules.
Official Florida Medicaid Fee Schedules for 2026
AHCA maintains current PDF files and, for many schedules, Excel versions. The official directory should be treated as the primary source when checking a rate or effective date.
Practitioner Fee Schedule
Effective date: January 1, 2026
The 2026 Practitioner Fee Schedule is a large procedure-level file covering professional services. It includes information such as procedure codes, modifiers, facility and non-facility indicators, and other billing/payment fields.
AHCA publishes both PDF and Excel versions of the practitioner schedule.
Dental General Fee Schedule
Current updated effective date: July 1, 2026
AHCA lists an updated Dental General Fee Schedule effective July 1, 2026, with both PDF and Excel versions available through the agency’s provider reimbursement schedule directory.
Durable Medical Equipment Fee Schedule
Current updated effective date: July 1, 2026
AHCA lists an updated Durable Medical Equipment and Medical Supply Services fee schedule effective July 1, 2026.
DME reimbursement should be reviewed at the HCPCS-code level together with applicable units, modifiers, authorization requirements, and billing rules.
Prescribed Pediatric Extended Care (PPEC)
Current updated effective date: July 1, 2026
The 2026 PPEC fee schedule provides rates for specific PPEC services. The current schedule lists:
| Code | Service | Maximum fee |
|---|---|---|
| T1025 | Full-day PPEC services, five to twelve hours | $281.68 |
| T1026 | Partial-day PPEC services, four hours or less | $44.73 |
AHCA also specifies the billing unit rules for T1026. These are PPEC-specific rates and should not be treated as general pediatric Medicaid rates.
Family Home Health Aide
Current updated effective date: July 2, 2026
AHCA lists a July 2, 2026 Family Home Health Aide Fee Schedule. This is one example of why a generic “2026 Florida Medicaid rate” can become outdated during the year.
Other Major 2026 Schedules
AHCA’s current provider reimbursement directory also includes schedules for:
- Behavior Analysis
- Behavioral Health Overlay Services
- Birth Center
- Child Health Targeted Case Management
- Early Intervention
- Hearing Services
- Home Health Visit Services
- Hospice
- Independent Laboratory
- Licensed Midwife
- Mental Health Targeted Case Management
- Occupational Therapy
- Personal Care
- Physical Therapy
- Physician Pediatric Surgery
- Private Duty Nursing
- Radiology
- Respiratory Therapy
- Specialized Therapeutic Services
- Speech-Language Pathology
- Transportation
- Visual Services
The exact effective date should be checked against the current AHCA directory rather than assumed from another provider category.
How to Look Up a Florida Medicaid Reimbursement Rate
Looking up a Florida Medicaid rate is more reliable when you follow the same process every time.
Step 1: Identify the Service Category
First determine what type of service you are researching.
A physician office visit, ABA service, dental procedure, DME item, therapy service, and PPEC service may all appear in different schedules.
Step 2: Open the Correct AHCA Fee Schedule
Use the AHCA Rule 59G-4.002 provider reimbursement schedule directory and select the schedule that matches the service.
Do not assume the Practitioner Fee Schedule contains every Medicaid service.
Step 3: Find the CPT or HCPCS Code
Search the PDF or Excel file for the relevant code.
For professional services, the code may be a CPT code. For certain supplies or Medicaid-specific services, it may be a HCPCS code.
Examples include:
- 99212
- 99213
- 99214
- 97153
- 97155
- T1017
- T1025
- T1026
The correct rate must always be verified against the applicable schedule.
Step 4: Check Modifiers and Provider Requirements
A CPT or HCPCS code by itself may not tell you the entire reimbursement rule.
Check whether the schedule specifies:
- Modifier requirements
- Provider type
- Facility versus non-facility treatment
- Prior authorization
- Service limitations
- Other billing conditions
Step 5: Check the Unit
The rate may represent:
- One visit
- One item
- One day
- One procedure
- A time-based unit
- Another defined billing unit
For example, the 2026 PPEC schedule specifies a unit structure for T1026.
Step 6: Check the Effective Date
Never rely solely on the year.
A January 1, 2026 schedule may have been replaced by a July 1, 2026 schedule for the same service category.
Always match the schedule to the date of service.
Step 7: Check FFS vs. Managed Care
Finally, determine whether the claim is being paid under a fee-for-service methodology or through a Medicaid managed-care plan.
The published AHCA fee schedule and a provider’s managed-care payment are not necessarily the same.
Florida Medicaid Fee-for-Service vs. Managed Care
This is one of the most important distinctions for providers.
Fee-for-Service (FFS)
Florida Medicaid publishes fee schedules for services paid under applicable fee-for-service methodologies.
When a service is subject to a published fee schedule, the AHCA schedule can provide the applicable published amount and billing information for the code.
Managed Care
Florida Medicaid also operates managed-care programs. A provider participating with a Medicaid managed-care plan may be paid according to the provider agreement, plan policies, and applicable reimbursement terms.
Therefore:
An AHCA FFS fee-schedule rate should not automatically be assumed to be the same as a managed-care contract rate.
When researching managed-care reimbursement, check the relevant health plan’s:
- Provider contract
- Provider manual
- Fee schedule, if supplied
- Authorization policy
- Billing policy
- Claim-payment rules
This distinction is particularly important when a provider is using an online Medicaid fee-schedule table to estimate expected payment.
Florida Medicaid CPT and HCPCS Reimbursement Rates
There is no single universal table of every Florida Medicaid CPT and HCPCS reimbursement amount.
Instead, AHCA maintains separate schedules based on the provider and service category.
For example, a search for:
- Florida Medicaid 99213 reimbursement
- Florida Medicaid 99214 reimbursement
- Florida Medicaid 97153 reimbursement
- Florida Medicaid 97155 reimbursement
- Florida Medicaid T1017 reimbursement
- Florida Medicaid T1025 reimbursement
should be answered by identifying the correct current AHCA schedule and then checking the specific code.
Important correction about common office-visit rates
Amounts such as $28.14, $34.29, and $53.43 should not be presented as universal statewide Florida Medicaid reimbursement rates for CPT 99212, 99213, and 99214.
AHCA materials identify specific conditions and provider categories associated with those amounts. They should not be generalized to every Medicaid provider or patient.
For an exact payment amount, use the current applicable AHCA schedule and verify:
- CPT code
- Provider type
- Modifier
- Patient/service category
- Effective date
- Payment methodology
Do Florida Medicaid Rates Vary by County?
Not every Florida Medicaid fee-schedule rate varies by county.
Some rates are established through statewide fee schedules, while other methodologies can include geographic factors.
One important example is the MMA Physician Incentive Program (MPIP), which uses Medicare or Medicare-equivalent payment methodology and can incorporate Medicare locality information.
Therefore, it is more accurate to say:
Some Florida Medicaid payment methodologies can involve geographic factors, but you should not assume that every standard Medicaid fee-schedule rate changes by county.
Florida Medicaid MPIP Rates for 2025–2026
The MMA Physician Incentive Program (MPIP) is a special enhanced-payment program and is different from the standard Florida Medicaid fee schedule.
The current 2025–2026 program year runs from:
October 1, 2025 through September 30, 2026.
For qualifying services and providers, AHCA states that the program includes a legislative increase to 106.3% of the applicable Medicare or Medicare-equivalent rate, subject to the program’s specific eligibility and calculation rules.
Who Can Qualify for MPIP?
AHCA identifies multiple provider groups, including:
- Pediatric primary care physicians
- OB/GYNs
- Specialty physicians providing qualifying services to members under age 21
Eligibility requirements differ by provider category.
For example, AHCA describes specific qualification rules for pediatric primary care physicians and OB/GYNs, while specialty physician eligibility follows a different structure.
Important MPIP Warning
Do not take the 106.3% figure and multiply every Florida Medicaid rate by 1.063.
MPIP is an enhanced payment methodology for qualifying providers and qualifying services. The applicable amount depends on the program rules and the relevant Medicare or Medicare-equivalent calculation.
For billing or payment modeling, use AHCA’s current MPIP methodology rather than applying a flat multiplier to unrelated Medicaid fee-schedule rates.
2025–2026 MPIP Vaccine Administration Rates
AHCA’s 2025–2026 MPIP materials list the following maximum fees for vaccine-administration services:
| CPT code | Description | Maximum fee |
|---|---|---|
| 90460 | First vaccine/toxoid administration through age 18 with counseling | $24.01 |
| +90461 | Each additional vaccine/toxoid component with counseling | $12.00 |
| 90471 | Administration of one vaccine | $24.01 |
| +90472 | Each additional vaccine administration | $12.00 |
| 90473 | Oral/intranasal administration of one vaccine | $24.01 |
| +90474 | Each additional oral/intranasal administration | $12.00 |
These amounts are specifically associated with the MPIP model and should not be treated as a general Medicaid vaccine-rate table for every payment methodology.
Florida Medicaid PPEC Reimbursement Rates
The current 2026 PPEC Fee Schedule is effective July 1, 2026.
AHCA lists:
| Code | Description | Maximum fee |
|---|---|---|
| T1025 | Full-day PPEC services, five to twelve hours | $281.68 |
| T1026 | Partial-day PPEC services, four hours or less | $44.73 |
The schedule also contains billing and unit instructions for these services.
These amounts are specifically for the PPEC schedule and should not be used as general pediatric Medicaid reimbursement rates.
What Is Included in the Florida Medicaid Practitioner Fee Schedule?
The 2026 Practitioner Fee Schedule is a detailed procedure-level file.
Depending on the line item, you may need to review fields such as:
- Procedure code
- Modifier
- FSI
- Facility
- PCI
- TCI
- Prior-authorization indicator
- Applicable reimbursement information
AHCA publishes the 2026 practitioner schedule in PDF format and provides an Excel version that can be easier to search when working with many codes.
For providers and billers, the Excel file can be particularly useful for:
- Searching a large number of CPT codes
- Filtering modifiers
- Comparing codes
- Building internal rate-reference spreadsheets
- Checking whether a code appears in the current schedule
Florida Medicaid Dental Fee Schedule 2026
The Dental General Fee Schedule currently listed by AHCA is effective July 1, 2026.
AHCA provides the updated schedule in PDF and Excel formats through the provider reimbursement schedule directory.
When researching a dental reimbursement rate, use the July 1, 2026 schedule rather than an older 2025 or early-2026 file.
Florida Medicaid DME Fee Schedule 2026
The Durable Medical Equipment and Medical Supply Services schedule currently listed by AHCA has an effective date of July 1, 2026.
DME reimbursement may depend on more than the HCPCS code.
Before estimating payment, verify:
- HCPCS code
- Modifier
- Unit
- Rental versus purchase status, where applicable
- Prior authorization
- Medical necessity
- Provider requirements
- Effective date
Florida Medicaid ABA Fee Schedule 2026
Florida Medicaid has a dedicated Behavior Analysis Fee Schedule, currently listed by AHCA with a January 1, 2026 effective date.
ABA reimbursement should be analyzed at the code and billing-condition level rather than by using one general “ABA rate.”
Depending on the service, the relevant information may include:
- CPT code
- Modifier
- Provider category
- Unit
- Authorization
- Service limits
- Effective date
Third-party billing resources can help identify commonly searched ABA codes, but the AHCA schedule should be used as the primary source when verifying the official Florida Medicaid rate.
Florida Medicaid Therapy Fee Schedules
AHCA maintains separate schedules for multiple therapy services, including:
- Physical Therapy
- Occupational Therapy
- Speech-Language Pathology
- Respiratory Therapy
- Specialized Therapeutic Services
The current provider reimbursement directory lists 2026 schedules for these categories.
Therapy payment may depend on the specific CPT code and unit structure, so a general “Florida Medicaid therapy rate” is not sufficiently precise for billing.
Florida Medicaid Home Health and Hospice Schedules
AHCA separately publishes:
- Home Health Visit Services
- Family Home Health Aide
- Hospice Services
The current Family Home Health Aide schedule is effective July 2, 2026, while the current Home Health Visit Services and Hospice schedules listed in the directory use their respective 2026 effective dates.
Providers should match the specific service to the correct AHCA schedule rather than using a generic home-health reimbursement rate.
How to Read a Florida Medicaid Fee Schedule
A Florida Medicaid fee schedule contains more information than simply a procedure code and dollar amount.
Procedure or CPT/HCPCS Code
This identifies the service, procedure, supply, or other billable item.
Modifier
A modifier can change the interpretation or reimbursement conditions of a service.
Never assume that one code always produces the same payment regardless of modifier.
Unit
The unit tells you what the listed amount represents.
Depending on the schedule, this could be:
- A visit
- A day
- An item
- A procedure
- A time-based unit
Maximum Fee
Where the schedule uses a maximum-fee structure, the published amount is the applicable maximum under the schedule’s conditions.
It should not automatically be interpreted as the guaranteed payment on every claim.
Provider-Specific Fields
Some schedules contain fields that distinguish:
- Provider type
- Facility/non-facility setting
- Other payment categories
- Prior authorization
- Special billing conditions
Effective Date
This is one of the most important fields in the entire document.
The rate for a code can change when AHCA publishes a new schedule.
Why the Effective Date Matters
Florida Medicaid fee schedules do not all change on the same date.
For example, AHCA currently lists July 2026 updates for:
- Dental
- DME
- PPEC
- Family Home Health Aide
while many other provider schedules have January 1, 2026 effective dates.
This means:
“What is the Florida Medicaid rate in 2026?” is incomplete without asking which service and which date of service.
For billing purposes, always use the schedule that applies to the actual date of service.
Does Every Florida Medicaid Service Use a Fee Schedule?
No.
Florida Medicaid uses different reimbursement methodologies depending on the service.
For example, AHCA maintains separate information for hospital inpatient reimbursement under Florida’s Diagnosis Related Group (DRG) system, including FY 2026–2027 resources effective July 1, 2026.
Therefore, this page should be viewed as a guide to Florida Medicaid provider fee schedules and related reimbursement information, not as a claim that every Medicaid service is paid from one universal fee schedule.
How to Avoid Using an Outdated Florida Medicaid Rate
Before using a rate for billing, contracting, payment analysis, or reimbursement estimates:
- Identify the exact service.
- Identify the provider type.
- Find the applicable AHCA fee schedule.
- Search the exact CPT or HCPCS code.
- Check modifiers.
- Check the unit.
- Check the effective date.
- Determine whether the payment is FFS or managed care.
- Review any authorization and billing requirements.
- Verify the final amount against the current official AHCA source.
For large numbers of codes, the Excel version of the AHCA schedule may be easier to work with than the PDF.
Florida Medicaid Fee Schedule Download
The official Florida Medicaid provider reimbursement schedules are available through the AHCA Rule 59G-4.002 provider reimbursement schedules and billing codes page.
AHCA provides current schedule files in PDF format and, for many categories, Excel format.
When downloading a fee schedule:
- Check the file name.
- Check the effective date.
- Check whether it is an updated replacement.
- Confirm the provider/service category.
- Save the official file you used for your research.
This is especially important when comparing rates across months or years.
Frequently Asked Questions
What Is the Florida Medicaid Fee Schedule for 2026?
Florida Medicaid does not use one universal fee schedule for all services. AHCA publishes separate 2026 provider reimbursement schedules for different service and provider categories.
Where Can I Find the Official Florida Medicaid Fee Schedule?
The official schedules are published by the Florida Agency for Health Care Administration (AHCA) on its Rule 59G-4.002 provider reimbursement schedules and billing codes page.
Can I Download the Florida Medicaid Fee Schedule in Excel?
Yes. AHCA provides Excel files for many fee schedules, including major provider schedules. The availability of PDF and Excel files varies by schedule.
Does Florida Medicaid Have One Reimbursement Rate for Every CPT Code?
No. Rates vary by service category, applicable fee schedule, provider requirements, modifiers, units, effective dates, and payment methodology.
Are Florida Medicaid FFS Rates the Same as Managed-Care Rates?
Not necessarily. An AHCA FFS fee-schedule amount should not automatically be assumed to be the same amount paid under a managed-care provider contract.
How Do I Look Up a Florida Medicaid CPT or HCPCS Rate?
Find the correct AHCA schedule for the service, search the CPT or HCPCS code, and then review the modifier, unit, provider requirements, and effective date.
What Is the Current PPEC Rate in Florida Medicaid?
The current 2026 PPEC schedule lists $281.68 for T1025 full-day services and $44.73 for T1026 partial-day services, subject to the conditions in the AHCA schedule.
What Is the Florida Medicaid MPIP Rate?
For the 2025–2026 MPIP program year, AHCA states that qualifying providers can receive enhanced payments, including a legislative increase to 106.3% of applicable Medicare or Medicare-equivalent rates, subject to the program’s eligibility and payment methodology.
Are the $28.14, $34.29 and $53.43 Amounts Universal Florida Medicaid Office-Visit Rates?
No. Those amounts should not be presented as universal statewide rates for CPT 99212, 99213, and 99214. They relate to specific AHCA reimbursement circumstances and provider/service categories.
Does Miami Have Different Florida Medicaid Rates?
Not every Florida Medicaid fee-schedule rate varies by county. Some payment methodologies can use geographic factors, including Medicare-linked calculations such as MPIP.
Do not assume every standard Medicaid fee-schedule rate has a separate Miami rate.
How Often Does Florida Medicaid Update Fee Schedules?
Different schedules can be updated at different times. AHCA’s current 2026 directory includes schedules effective January 1, July 1, and July 2, 2026, depending on the provider/service category.
Can I Use This Page Instead of the Official AHCA Schedule?
Use this page as a research guide and explanation of the Florida Medicaid fee-schedule system. For billing, reimbursement, contracting, and payment decisions, verify the exact rate against the current official AHCA schedule and any applicable managed-care plan rules.
Florida Medicaid Fee Schedule 2026 Update History
August 24, 2026: Reviewed the current AHCA provider reimbursement schedule directory and updated the article to reflect current 2026 effective dates.
August 24, 2026: Added July 2026 updates for Dental, DME, PPEC, and Family Home Health Aide schedules.
August 24, 2026: Corrected the presentation of pediatric E&M rates so that specialized rates are not described as universal Florida Medicaid reimbursement amounts.
August 24, 2026: Clarified Florida Medicaid fee-for-service versus managed-care reimbursement.
August 24, 2026: Updated the MPIP explanation and removed unsupported generalized Medicare-rate estimates.
August 24, 2026: Expanded CPT/HCPCS lookup guidance, provider-specific schedules, units, modifiers, effective dates, and official-source verification.
We will update this page when AHCA publishes a material fee-schedule change.
Sources and Methodology
This article is based primarily on official Florida Medicaid and AHCA materials.
Florida AHCA — Provider Reimbursement Schedules and Billing Codes
Rule 59G-4.002, Provider Reimbursement Schedules and Billing Codes is the primary directory for Florida Medicaid provider fee schedules, current files, and effective dates.
Florida AHCA — 2026 Practitioner Fee Schedule
AHCA’s 2026 Practitioner Fee Schedule provides detailed procedure-level reimbursement information and billing fields.
Florida AHCA — 2026 PPEC Fee Schedule
The 2026 PPEC Fee Schedule is effective July 1, 2026 and provides the current PPEC reimbursement information cited in this article.
Florida AHCA — 2025–2026 MPIP
AHCA’s 2025–2026 MPIP materials cover the October 1, 2025 through September 30, 2026 program year and explain the applicable enhanced-payment methodology.
Florida AHCA — DRG Inpatient Payment
Hospital inpatient services can use separate reimbursement methodologies, including Florida’s DRG system. AHCA provides FY 2026–2027 DRG resources effective July 1, 2026.
Disclaimer
CheckMedicaid.com is an independent informational website and is not affiliated with or endorsed by the Florida Agency for Health Care Administration or another government agency.
This article is provided for educational and informational purposes. It is not a substitute for the current official AHCA fee schedule, Florida Medicaid provider agreement, managed-care contract, billing manual, authorization policy, or professional billing advice.
When an exact reimbursement amount matters, always verify the current official AHCA schedule, effective date, code, modifier, unit, provider requirements, and applicable payment methodology before relying on the information.
