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Florida Medicaid Reverses Professional Component Payment Decision

To provide some background, Florida Medicaid was one of the few state Medicaid plans paying for the professional component of clinical pathology.  In the agency’s January 2020 fee schedule update, split reimbursement for the professional and technical component on the majority of clinical pathology tests was removed, and the fee schedule only allowed for global reimbursement.   

We are happy to report that in the most recently released 2020 fee schedule update by the AHCA-Agency for Healthcare Administration (aka Florida Medicaid), the agency reversed the decision to stop paying the professional component of clinical pathology.  The AHCA has restored the professional component reimbursement for the vast majority of the over 1,000 eligible clinical lab tests.  

Please click here for the complete listing of the updated 2020 practitioner laboratory fee schedule from the Agency for Healthcare Administration. 

APS looks to provide ongoing support to our clients to help identify new carrier policies and billing updates.  As always, APS will continue to monitor and provide updates as they become available.

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APS has completely fulfilled all of our expectations, both in clinical pathology professional component billing and in all other areas of pathology billing.

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