Understanding Florida Medicaid Durable Medical Equipment fee schedules is not easy, even for the experts. It feels like translating a foreign language or deciphering an alien script.
The finalized Florida Medicaid Durable Medical Equipment (DME) and Medical Supply Services Fee Schedule is more than just a list of codes and prices. Effective from July 1, 2026, it is the operational blueprint for how billing departments must submit DME claims. The latest fee schedule clarifies how clinical case managers, billers, and DME suppliers must ensure patients receive life-sustaining equipment without administrative delays.
To keep your clinic/medical facility in the Sunshine State compliant and patients fully supported, today’s detailed guide bridges the gap between technical billing requirements and clinical coverage limits.
Florida Medicaid DME Fee Schedule 2026 Rates
➜ The July 1, 2026 schedule covers 1,525 HCPCS codes across nine categories, plus 219 covered enteral formulas. Of those, 1,355 carry a fixed dollar rate; the rest are handled another way — 39 are rental-only, 28 are manually priced through the Agency’s QIO vendor, and 6 are paid by report after medical review.
➜ Rates span an enormous range, from $0.04 to $17,382.60, with a median of $83.26. The distribution is heavily bottom-weighted: about 40% of priced codes fall under $50, while only 167 clear $1,000. That split is really a split between supplies and equipment.
➜ Consumables sit near the floor — continence supplies run $0.47 to $1.63 per unit, and ostomy, wound care and diabetic supplies have a median of just $5.31, with the cheapest items on the whole schedule (A4395 and A6216) at four cents.
➜ Durable equipment sits far higher: accessibility aids median $114, orthotics and prosthetics $187, the QIO prior-authorization guide $1,253, and the four surgically implantable devices from $8,691 to $17,382.60 for L8679.
➜ The single highest line-item fee is E0483, high-frequency chest wall oscillation, at $11,455.62.
➜ Most everyday respiratory equipment is rental-only, reimbursed monthly rather than purchased: CPAP (E0601) at $85.87 a month, oxygen concentrator (E1390) at $182.93, portable gaseous oxygen (E0431) at $41.34, and home ventilators (E0466) at $811.83.
➜Mobility and home equipment are mostly purchase rates with a rental option at roughly 10% of purchase price per month — a standard manual wheelchair (K0001) is $380.16 or $38.02 monthly, lightweight (K0003) $623.52, and a power wheelchair (K0823) $3,969.78 with prior authorization required.
➜ Other frequently billed items include a semi-electric hospital bed (E0260) at $1,150.10, a folding walker (E0143) at $92.54, a nebulizer (E0570) at $114.49, and a commode chair (E0163) at $77.02.
➜ 112 codes require prior authorization before the service is performed, and nearly every item carries a frequency limit — often “1 per 5 years” for wheelchairs, “1 per 8 years” for beds, or a monthly unit cap for supplies — so the limit column governs billing at least as much as the fee does.
Florida Medicaid DME and medical supply fee schedule
Search any HCPCS code across every category at once, or filter down to one. Rates are the maximum Florida Medicaid will pay a fee-for-service provider.
No codes match. Try the HCPCS code on its own, or clear the filters above.
What the columns and flags meanShowHide
Codes marked OS are reimbursable to physicians with an orthopedic specialty as well as DME providers. Codes without OS are reimbursable only to DME providers.
The equipment remains the property of the provider. A monthly fee is reimbursed during the authorized medically necessary time frame.
The rental amount is reimbursed on a daily basis rather than per month.
The reimbursement rate must be negotiated between the provider and the Agency’s contracted quality improvement organization.
The rental amount includes all supplies needed to operate the equipment for the whole rental period. These cannot be billed separately and the provider must replace them when needed.
A non-classified procedure code that requires medical review to approve and price correctly.
Requires prior authorization by the Agency’s fee-for-service QIO vendor before the service is performed, including requests to exceed limits or for services not on the fee schedule.
A temporary rate assigned because of specific circumstances, such as a state of emergency or a supply shortage.
The most Florida Medicaid will pay for the item. Unless the description says otherwise, it is the fee for a single item or each unit. For ostomy supplies it is per stoma or per fistula.
The covered age range for the service. A range ending in 999 means there is no upper age limit.
How many units may be billed for dates of service within the same month. A provider may bill up to a one-month supply on a single billing date, based on medical need.
The maximum limit that applies to the procedure code.
The monthly amount reimbursed for rental-only and rent-to-purchase items.
Source: Florida Medicaid Durable Medical Equipment and Medical Supply Services provider fee schedule, effective July 1, 2026. Fees are maximums for the fee-for-service delivery system and may differ from managed care plan rates. Codes marked manually priced or by report are negotiated or reviewed by the Agency’s QIO vendor. Confirm current rates with AHCA before billing.
Simplifying FL Medicaid DME Billing for Billing & Compliance Teams
Florida Medicaid has organized its DME fee schedule in a 14-column system. Misunderstanding a single column modifier or considering it unimportant can result in claim denials, delayed payments, or compliance audits.
Here is a breakdown of how to read and apply these fields in daily practice to ensure zero hiccups going forward.
Orthopedic Specialty (OS) Reimbursement Rules
One of the most common billing errors involves the OS (Orthopedic Specialty) column.
For instance:
➜ A Code is Marked OS
If a code is marked OS in the third column, Florida Medicaid reimburses the procedure code to physicians specializing in orthopedics and also to DME providers.
➜ A Code is not marked OS
In such a scenario, the code is strictly reimbursable to DME providers only. Orthopedic specialists cannot bill these codes. If they do so, the payor will flag the claim as fraudulent, and it will result in immediate denial.
Example: Code L0120 (Cervical collar) with a maximum fee of $13.02 is designated as OS in the latest DME fee schedule, making it billable to orthopedic physicians as well as DME providers. On the other hand, those codes that don’t have OS in the third column remain the exclusive domain of enrolled DME providers.
Maximum Fees vs. Non-Classified Pricing
The Maximum Fee column lists the unilateral rate that Medicaid pays for a single item or unit, unless the description specifies otherwise.
Ostomy Supplies Exception
On the first page of this extensive document, Florida Medicaid clearly states that maximum fees for ostomy supplies are billed per stoma or per fistula, rather than per patient, unless otherwise indicated. This is crucial for patients with multiple stomas who require custom supply quantities.
Non-Classified Codes Listed as $0.00
When a code is showing a maximum fee of $0.00, it is considered non-classified. Simply put, there is no predetermined maximum reimbursement amount for that code.
To collect deserved payment, Durable Medical Equipment providers must request Prior Authorization (PA) or submit a By Report (BR) claim containing detailed clinical documentation.
Rental Structures like Rental Only (RO), Daily Rental (DR), and Bundled Code (BC)
To make it easy for stakeholders, Florida Medicaid has clearly differentiated between purchasing and renting durable medical equipment. Here are the rental structures explained briefly.
Rental Only (RO)
Under an RO designation, the equipment remains the DME provider’s property. Medicaid pays a monthly rental fee for the authorized, medically necessary time frame. For example, standard oxygen concentrators such as the E0424 are designated as RO.
Daily Rental (DR)
Some rentals are reimbursed on a daily basis rather than monthly. For example, pediatric apnea monitors with codes E0618 and E0619 fall under the daily rentals category with a rate of $6.60 per day.
Bundled Code (BC)
This is a critical compliance checkpoint. A BC designation in the tenth column of the latest FL Medicaid DME fee schedule indicates that the monthly rental comprises all necessary supplies to operate the equipment.
DME providers cannot bill for supplies separately and must provide replacements without any additional cost. Ventilator rentals (E0465 and E0466) with a rental fee of $811.83 are prominent examples of bundled codes.
Prior Authorization (PA) and By Report (BR) Claims
Prior Authorization (PA)
Codes marked with PA in the 12th column require explicit authorization from the Agency’s contracted Quality Improvement Organization (QIO) vendor before the service is performed. This includes requests to exceed the standard monthly unit limits or when requesting miscellaneous codes such as E1399.
By Report (BR)
Codes marked BR in the 11th column of the Florida Medicaid Durable Medical Equipment (DME) and Medical Supply Services Provider Fee Schedule indicate that the code is non-classified and requires a detailed clinical review during claims processing to ensure the service is approved and priced correctly.
Clinical Coverage and Patient Limits
For clinical coordinators and case managers, the 2026 fee schedule acts as a coverage manual. Knowing the unit limits on essential medical supplies prevents sudden coverage disruptions for vulnerable patients.
Continence & Incontinence Supplies: The 200 Combined Limit Rule
One of the most heavily scrutinized areas of DME coverage is continence supplies. Florida Medicaid enforces a strict monthly limit on disposable briefs and standard incontinence supplies.
HCPCS Codes
T4521* through T4544* represent various continence products of different sizes and styles such as diapers, pull-ons, and liners.
The Limit is up to 200 per month
Any combination of these codes can be billed for a patient, but the total cannot exceed 200 units per month.
What To Do?
When coordinating a patient’s care, case managers must calculate the exact daily usage. For instance, if a child requires more than 7 diapers a day, it will exceed the 200-unit monthly limit. In such a scenario, Prior Authorization may be required depending on the applicable code to document extreme medical necessity.
The 930-Unit Standard for Enteral Nutrition & Formulas
Medicaid provides robust coverage for enteral nutrition. However, pediatric and adult lines of support are strictly divided by age and brand grouping. The standard monthly limit for most formulas is 930 units per month.
FL Medicaid categorizes formulas under specific billing codes, which align with brand-name products:
HCPCS B4149/B4149SC (Age 0–20, Limit 930/month)
For specialized pediatric blended whole-food formulas.
Covered brands include Compleat Pediatric, Kate Farms Pediatric Blended Meals (Banana & Blue, Mango & Straw, Squash & Carrot), Nourish Original, Real Food Blends (Turkey, Chicken, Beef, Salmon, Quinoa, Eggs), and Liquid Hope.
HCPCS B4150/B4150SC (Age 0–999, Limit 930/month)
Standard intact formulas.
Covered brands include Boost, Ensure, Jevity (1 Cal, 1.2 Cal), Fibersource HN, Isosource HN, Osmolite, Nutren 1.0, and Kate Farms Standard 1.0/1.4.
HCPCS B4153/B4153SC (Age 0–999, Limit 930/month)
Hydrolyzed or peptide-based formulas for severe malabsorption.
Brands include Peptamen (1.5, AF, with PreBio1), Vital (1.0, 1.5, AF, HN), Impact Peptide 1.5, and Kate Farms Peptide 1.0/1.5.
HCPCS B4160/B4160SC (Age 0–20, Limit 930/month)
Pediatric-specific standard formulas.
Covers Boost Kid Essentials (standard and 1.5), Nutren Junior, PediaSure (standard, 1.5 Cal, Enteral), and Kate Farms Kids Nutrition.
HCPCS B4161/B4161SC (Age 0–20, Limit 930/month, By Report)
Specialized pediatric elemental and metabolic formulas.
Covers EleCare, EleCare Junior, Neocate (standard, Junior, Nutra), Puramino Infant/Junior, Similac Expert Care Alimentum, PediaSure Peptide, and Peptamen Junior.
Case managers must match the patient’s exact age and medical diagnosis to these codes to ensure the correct formula is delivered and reimbursed.
Custom Mobility & The QIO Wheelchair Reference Guide
For complex rehabilitation, such as custom power wheelchairs, standard fee schedule rates do not apply directly. Instead, Florida Medicaid utilizes a specialized QIO Prior Authorization Pricing Reference Guide.
- Under this guide, specialized codes (such as E1006 at $5,130.36 or K0828 at $5,764.52) are priced and authorized directly by the Agency’s contracted QIO vendor.
- These codes are submitted strictly in conjunction with custom wheelchair builds and wheelchair repair requests. Providers must provide comprehensive clinical evaluations from physical or occupational therapists to secure QIO approvals.
Quick Reference Data Tables
To streamline your daily workflow, we have compiled the essential compliance rules and key benchmarks directly from the latest DME and Medical Supply Services Provider Fee Schedule into three easy-to-use tables.
Florida Medicaid Column Compliance Quick-Reference
Clinical managers and care coordinators must use this table as a training tool for new billing staff to prevent common modifier errors.
| Column Modifier | Full Title | Operational Definition & Billing Action Required |
| OS | Orthopedic Specialty | If active, physicians with an orthopedic specialty and DME providers can bill. If blank, only DME providers are reimbursed. |
| RO | Rental Only | Equipment remains provider property. Reimbursed via monthly rental rates. Do not submit as a purchase. |
| DR | Daily Rental | Equipment is reimbursed on a daily basis (e.g., pediatric apnea monitors). |
| BC | Bundled Code | Rental fee includes all operating supplies. Separate supply billing is prohibited. |
| MP | Manually Priced | Rate must be negotiated with the Agency’s contracted QIO vendor. |
| BR | By Report | Requires manual clinical review and a detailed report to determine pricing and approval. |
| PA | Prior Authorization | Requires QIO approval before delivering items or services to the patient. |
| TL | Time Limited Rate | Temporary rate assigned due to public health emergencies or major supply shortages. |
Benchmark DME Limits & Coverage Thresholds
Here are standard monthly limits, age restrictions, and reimbursement rates for high-frequency billing categories.
| HCPCS Code | Category | Covered Age | Maximum Fee / Rate | Standard Quantity Limit | Key Compliance Detail |
| T4521 to T4544* | Continence Supplies | 4 – 999 | Varies ($0.47 to $1.63) | Up to 200 units/month | Limit is the combined total across all diaper/liner codes used. |
| B4149 | Specialized Enteral Formula | 0 – 20 | $1.63 | 930 units/month | Covers brands like Kate Farms Pediatric Blended, Real Food Blends. |
| B4150 | Standard Enteral Formula | 0 – 999 | $0.67 | 930 units/month | Standard intact formulas like Jevity, Ensure, Boost. |
| B4160 | Pediatric Standard Formula | 0 – 20 | $0.84 | 930 units/month | Standard kids’ formulas like PediaSure, Nutren Junior. |
| E0424 | Oxygen Concentrator Rental | 0 – 999 | $228.98/month | 1 unit/month | Rental Only (RO) designation. |
| E0465 | Home Ventilator (Invasive) | 0 – 999 | $811.83/month | Medical Necessity | Rental Only (RO); Bundled Code (BC) includes all circuits. |
| E0618 | Pediatric Apnea Monitor | 0 – 20 | $6.60/day | Medical Necessity | Daily Rental (DR) structure; Bundled Code. |
Enteral Brand and Code Groupings Reference
Case managers can use this reference to quickly verify which HCPCS code corresponds to a prescribed brand-name formula.
| HCPCS Code | Covered Age Range | Example Brand Names Covered |
| B4149/B4149SC | 0 – 20 | Kate Farms® Pediatric Blended Meals, Real Food Blends® (Turkey, Chicken, Beef, Salmon), Nourish, Liquid Hope |
| B4150/B4150SC | 0 – 999 | Jevity® (1 Cal, 1.2 Cal), Ensure®, Boost®, Isosource® HN, Fibersource® HN, Kate Farms® Standard 1.0 / 1.4, Nutren® 1.0 |
| B4152/B4152SC | 0 – 999 | Promote®, Boost Plus®, Ensure Complete®, Ensure Plus®, Jevity® 1.5, Nutren® 1.5 / 2.0 |
| B4153/B4153SC | 0 – 999 | Vital® (1.0, 1.5 Cal, HN), Peptamen® (standard, 1.5, AF), Kate Farms® Peptide 1.0 / 1.5, Liquid Hope Peptide |
| B4154/B4154SC | 0 – 999 | Glucerna® 1.5, Nepro®, Kate Farms® Glucose Support, Kate Farms® Renal Support, KetoCal®, KetoVie® |
| B4155/B4155SC | 0 – 999 | Beneprotein®, Duocal®, MCT Oil, MCT procal, Polycose®, ProMod® |
| B4160/B4160SC | 0 – 20 | PediaSure® (standard, Enteral, 1.5 Cal), Boost Kid Essentials®, Kate Farms® Kids Nutrition, Nutren Junior® |
| B4161/B4161SC | 0 – 20 | EleCare® (Infant, Junior), Neocate® (standard, Junior), Puramino (Infant, Jr), PediaSure Peptide®, Peptamen Junior® |
Compliance Checklist for Providers and Care Coordinators
To minimize denials and keep your clinical and billing workflows running smoothly under the active July 1, 2026 schedule, use this checklist to audit your current processes.
1). Review Your Physician Specialty Billing
To stay compliant with Florida Medicaid guidelines, verify that you have cross-referenced your active physician rosters with codes tagged as OS. Confirm that standard orthopedic physicians on your staff are only billing ‘OS’ codes, and ensure all non-OS clinical orders are sent to enrolled DME providers. It helps you avoid immediate denials under the new rules.
2). Review Ventilator and Oxygen Supply Claims
Confirm that your billing team has disabled separate line-item billing for consumable supplies like filters, tubing, and mask replacements used with rental items classified as BC (Bundled Code). Any separate bills submitted for these items violate Medicaid policy.
3). Implement Diaper Limit Safeguards
Integrate a warning in your billing software for codes T4521 through T4544. If a single patient’s monthly claim exceeds 200 units, flag the account automatically so case managers can submit a Prior Authorization request to secure approval before item delivery.
4). Update Nutritional Authorization Templates
Train clinical coordinators to verify patient ages against enteral formulas. For instance, do not request standard pediatric formulas like PediaSure or Kate Farms Pediatric Blended for patients over the age of 20, as these codes B4149, B4160, B4161 carry a hard age limit of 0–20.
By combining billing compliance with clear clinical expectations, Florida DME providers and case managers can protect their organizations from financial losses while preserving the high-quality care Medicaid recipients depend on daily.
