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Proposed DME Provider Fee Schedule for …

Florida Medicaid Durable Medical Equipment and Medical Supply Services Provider Fee Schedule for Medicaid recipients Under the Age of 21 Years RENT-TO- BY PRIOR. MAXIMUM RENTAL LIMIT. CODE PURCHASE UNITS REPORT AUTHORIZATION. FEE ONLY. Medical and Surgical Supplies A4217 1 31 PER MONTH. A4221 1 52 PER YEAR. A4222 7 MEDICAL NECESSITY UP. TO 365 PER YEAR MAX. A4246 3 36 PER YEAR. A4255 1 2 PER MONTH. A4256 1 4 PER YEAR. A4265 6 72 PER YEAR. Incontinence Appliances and Care Supplies A4310 2 24 PER YEAR. A4314 2 24 PER YEAR. A4315 2 24 PER YEAR. A4316 2 24 PER YEAR. A4320 31 372 PER YEAR. A4322 31 372 PER YEAR. A4326 31 372 PER YEAR. A4327 1 1 PER YEAR. A4328 2 24 PER YEAR. A4330 31 372 PER YEAR.

Florida Medicaid Durable Medical Equipment and Medical Supply Services Provider Fee Schedule for Medicaid Recipients Under the Age of 21 Years

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