Florida Medicaid DME Fee Schedule 2026: AHCA Rates

For durable medical equipment (DME) providers, the fee schedule serves as the foundation for all billing decisions. This document specifies how much the Florida Medicaid program will pay for items such as wheelchairs, nebulizers, ostomy supplies, or hospital bed rentals; it also establishes limits and rental rules, and determines who is authorized to bill for each item. Misinterpreting even a single column can lead to underbilling, claim denials, or unpleasant surprises during a payment audit.

This guide explains how the Florida Medicaid DME fee schedule published by the Agency for Health Care Administration (AHCA) functions in 2026, how to interpret it, how it relates to managed care plans, and what recent changes mean for providers.

What Is the Florida Medicaid DME Fee Schedule?

The AHCA is the state agency that administers Florida’s Medicaid program and publishes reimbursement schedules for providers in accordance with Rule 59G-4.002 of the Florida Administrative Code. Regarding equipment and supplies, the key document is the "Durable Medical Equipment and Medical Supply Services Provider Fee Schedule for All Medicaid Recipients." This document lists the maximum amount that Medicaid will pay for each covered HCPCS code, along with any applicable limits and details regarding rentals.

The AHCA publishes these schedules on its website dedicated to Medicaid fees; a version dated July 1, 2026, has already been finalized. Since the AHCA revises these schedules periodically, it is essential to note the effective date indicated in the document. Always ensure that you are using the version in effect on the date the service you are billing was provided.

An important point: this document establishes maximum rates, not guaranteed payments. The actual amount received may be affected by coverage policy, authorization status, the existence of third-party coverage, and the specific plan processing the claim payment.

How the 2026 Fee Schedule Is Organized

The fee schedule is a spreadsheet that includes an introductory page and separate tabs for each category of equipment, allowing providers to locate codes grouped by type for example: respiratory equipment, wheelchairs and mobility devices, orthotics and prosthetics, continence and ostomy supplies, and nutritional products. The introductory page explains the content of each column, so it is advisable to consult it whenever the list is updated.

Key Columns to Understand

1. Code: The HCPCS procedure code corresponding to the item or supply.
2. Age: Indicates age restrictions that may apply to coverage for the code.
3. Orthopedic Specialty (OS): Indicates whether the code is also eligible for reimbursement when billed by physicians specializing in orthopedics.
4. Maximum Rate: The maximum amount Medicaid will pay for the acquisition of the item or supply.
5. Rental Only: Identifies items for which coverage is limited to rental, excluding purchase.
6. Rental Amount and Daily Rental: The monthly or daily amounts paid when equipment is rented.
7. Units or Limit: The maximum quantity permitted for a code within a specified period.

Who Can Bill: The Orthopedic Specialty Designation

One detail that often confuses those new to medical billing is the "OS" indicator. Codes marked with "OS" can be reimbursed to both orthopedic specialists and suppliers of durable medical equipment (DME). Codes that lack this designation can only be reimbursed to suppliers of durable medical equipment. If your organization is not registered under the correct provider type, a claim may be denied even when the code, the fee, and the medical necessity are entirely correct.

Rental Rules and Bundled Supplies

Billing for rentals requires special attention. According to the cover page of the addendum, the rental fee for the covered equipment includes reimbursement for all supplies necessary for its operation throughout the entire rental period. In practice, this means that, generally, supply codes cannot be billed separately if they are already covered by the rental agreement. Doing so often leads to claim denials and can create compliance issues during audits.

For items intended exclusively for rental, it is also necessary to pay close attention to the duration and authorization. Keep track of start dates, monthly billing cycles, and any approved rental periods to ensure that claims align with the authorization on file.

Coverage Policies Behind the Rates

The fee schedule indicates which items are reimbursable, while coverage policies specify the circumstances under which such reimbursement is permitted. Florida Medicaid publishes its coverage policies for durable medical equipment (DME) and medical supplies, categorized by type; these include specialized equipment, orthotics and prosthetics, respiratory equipment, wheelchairs, hospital beds and mobility aids, incontinence products, ostomy and wound care supplies, as well as enteral and parenteral nutrition. Several of these policies were incorporated into the regulations in effect as of 2024, including rules 59G-4.072, 59G-4.073, 59G-4.076, and 59G-4.077.

Each policy details criteria for medical necessity, documentation requirements, replacement limits, and age-related guidelines. A payment request that aligns with the fee schedule but fails to meet the requirements set forth in the coverage policy will be denied; therefore, billing staff must consult both documents concurrently.

Fee-for-Service vs. Managed Care

Most Medicaid beneficiaries in Florida receive services through managed care plans rather than the fee-for-service model. This is significant for durable medical equipment (DME) providers, as they will generally need to bill the health plan rather than the Agency for Health Care Administration (AHCA) directly.

Managed care plans typically base DME reimbursement on the AHCA fee schedule, but they apply their own specific rules and authorization processes. For instance, guidelines published by one particular plan indicate that it follows the AHCA fee schedule and limits; furthermore, it requires prior authorization for DME purchases exceeding a certain dollar amount, as well as for equipment rentals and items not included in the fee schedule. This same plan notes that codes without an assigned rate require prior authorization and are reimbursed based on the manufacturer’s invoice plus an additional percentage. For enrollees in long-term care programs, authorization may be required for all DME-related services.

Because these conditions vary by plan and are subject to change, providers should verify the following points with each plan with which they have a contract:

1. Whether the plan pays at 100% of the AHCA fee schedule.
2. Which codes require prior authorization and the procedure for submitting such requests.
3. How codes that are not on the list or do not have an assigned price are reimbursed.
4. Deadlines for the timely submission of claims and the procedures for filing appeals.
5. Contractual terms that may differ from the published AHCA fee schedule.

If the rates stipulated in your contract are lower than those in the AHCA fee schedule, rate increases announced at the state level may not automatically apply to your situation. Therefore, it is advisable to review the contracts.

Rate Changes and Historical Context

Sometimes, providers assume that rates increase every year, but this is not the case. The AHCA implemented its most recent general rate adjustment for durable medical equipment (DME) for the 2023–24 fiscal year—effective October 1, 2023—in accordance with that year’s General Appropriations Act; at the time, industry media reported a net increase of 7.3 percent. Rates for specific codes may also change when the AHCA updates its fee schedule. Therefore, it is advisable to compare each new version against the previous one to identify which codes have been added, removed, or modified in terms of pricing, rather than assuming that your projected profit margin remains unchanged.

Enrollment Developments Suppliers Should Know About

Billing according to the fee schedule requires enrollment in the program; the year 2026 brought notable changes. On March 25, 2026, the AHCA announced a statewide moratorium on the enrollment of new durable medical equipment (DME) providers in the Florida Medicaid program, which took effect on March 20, 2026. Pending applications submitted on or before that date continued to be processed, and providers already enrolled were permitted to continue delivering authorized services and billing for them. The moratorium did not apply to providers operating as part of a pharmacy, hospital, or other type of medical entity, nor to businesses for which the supply of durable medical equipment is a secondary activity.

According to recent reports, the moratorium expired on September 19, 2026, and was not extended, meaning that new durable medical equipment providers may once again submit applications. As enrollment rules and measures to ensure program integrity continue to evolve, we recommend verifying current requirements directly with the AHCA before submitting any application.

Common Billing Mistakes with Florida Medicaid DME

1. Using an outdated fee schedule and expecting reimbursement rates that no longer apply
2. Billing separately for supplies during a rental period that already includes them
3. Ignoring unit limits, which leads to partial or total claim denials
4. Billing with codes that do not correspond to the provider type specifically, codes designated for other specialties (OS)
5. Failing to obtain prior authorization for rentals, high-cost purchases, or unpriced items
6. Overlooking age restrictions associated with a specific code
7. Failing to ensure documentation aligns with coverage policy particularly regarding medical necessity and physician orders
8. Missing claim submission deadlines, especially when delays in the authorization process result in delayed claim filings

Best Practices for Staying Accurate in 2026

1. Download and archive every version of the fee schedule, along with its effective date, so that you can verify the applicable rate for any date of service.
2. Carefully upload the rates into your billing system and, following each update, perform random checks on the codes with the highest usage volume.
3. Incorporate authorization tracking into your workflow, including rental periods and expiration dates.
4. Review the specific policies for each payer across all managed care plans—not just those under the AHCA.
5. Audit denials by reason code to identify recurring issues related to limits, modifiers, or documentation.
6. Analyze margins by code. Compare the maximum allowable rate against your acquisition and delivery costs to determine which products are profitable to keep in stock for Medicaid patients.
7. Stay informed about AHCA alerts and communications from health plans so that changes to policies or rates do not catch you off guard.

Final Thoughts

The Florida Medicaid fee schedule for durable medical equipment (DME) is far more than a simple price list. This document defines who is eligible to bill, how rentals function, what limits apply, and how reimbursement ties into coverage policies and managed care contracts. Providers who analyze it thoroughly, track version updates, and integrate authorization and documentation processes into their daily workflows are much better positioned to avoid denials and protect their profit margins in 2026.

At MedMaxBill, Inc. based in Levittown, New York we assist DME providers and healthcare professionals in managing billing accuracy, tracking authorizations, and resolving denials across various payers. If your team needs support navigating Medicaid fee schedules and ensuring your claims are error-free, contact MedMaxBill to learn how we can help.