AHCA Implements 7.3% Pediatric Rate Increase for Treating Children (Ages 0-20)

Date: 01/19/24

Fort Lauderdale, Florida

The Agency for Health Care Administration (AHCA) has adjusted the Practitioner payment methodology to include a pediatric rate increase of 7.3% for Physicians PT25 (M.D.) and PT26 (D.O.) serving recipients ages 0-20 years.

The pediatric rate increase was directed by the 2023-24 General Appropriations Act. This increase was implemented December 8, 2023, and the rates are effective October 1, 2023. 

Sunshine Health will pull all past claims eligible for adjustment and reimburse providers as needed. If providers have billed at rates lower than the new rate, they must submit a revised claim to receive additional funds.

No action is required from providers to receive the rate increase for future claims.

Providers can access Florida Medicaid billing information via Rule 59G-4.002, Provider Reimbursement Schedules and Billing Codes.

Questions?

If you have any questions, please call Sunshine Health Provider Services at 1-844-477-8313 or visit the Secure Provider Portal. Our Provider Engagement staff are also here to help answer questions. Visit the Find Your Administrator tool to confirm the individual supporting your specialty and region. We encourage you stay up to date on Sunshine Health provider notices by reviewing and bookmarking Provider News. 

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