Florida Medicaid 2020 Practitioner Laboratory Fee Schedule Update

On June 30 the FSP received an email alert from the Agency for Healthcare Administration (AHCA) with the notice of the publication of the updated 2020 Practitioner Laboratory Fee Schedule. Our review of the fee schedule clearly shows that AHCA has restored the vast majority of the 1,000 or more clinical lab tests eligible for the CP PC component, has even increased the global fee for more than 40 of these tests, and seems to have only left out a handful of tests previously reimbursed that paid for both components, these are:

They removed 80048-26.

They eliminated the PC on the 11 codes below:

  • 80047
  • 80048
  • 89050
  • 89051
  • 89055
  • 89060
  • 89125
  • 89160
  • 89190
  • 89220
  • 89230

They reduced the PC on 7 codes below:

  • 80406
  • 80439
  • 81432
  • 88346
  • 88350
  • 88366
  • 88381

The remainder of the long list of PC and TC “split” reimbursable tests is restored! Also, AHCA has added some additional HCPCS and CPT codes that were not previously enumerated. 

I would caution our readers that this update by AHCA needs to be properly noticed in the Florida Administrative Weekly, allowed 21 days for comments, and allowed any potential requests for a hearing, but we can only hope that it would not be logical that AHCA would change its mind again. 

We plan to summarize what we have learned at the upcoming FSP Town Hall Webinar on July 15th at 7:00 pm as planned, including any last-minute details and insights. Register online here.

What happened? The collective efforts of #FSP_TeamMedicaid, a handful of your FSP leaders, combined with “back channel” communications by a number of organizations and individuals, including the FMA, CAP, and the ASCP, supported by robust evidentiary documentation, may have well contributed to AHCA’s decision to reinstate our vital PC reimbursement - as was historically paid - and, for that, we are grateful to them for working with us on this issue. 

We must remain vigil for new developments in the weeks and months ahead. As we all know, it has been an eternal struggle over the years to maintain the vital “professional component” reimbursement for all Pathologists who toil daily, especially now, on the front lines of COVID, assuring the accuracy and precision of laboratory testing, evaluating, reporting, and recommending diagnostic and therapeutic interventions, supervising the complex operations of our laboratories, while, all the time, remaining legally responsible for the integrity of our laboratory systems. 

Morton H. Levitt, FCAP, MHA, MD
President, Florida Society of Pathologists

 

Publication Date: 
Wednesday, July 1, 2020 - 11:30am