FEATURED PRESENTATIONS · FLORIDA MEDICAID COMMUNITY BEHAVIORAL HEALTH
Covered services
& service limitations
These are the services covered under Florida Medicaid Community Behavioral Health. Each one comes with its own procedure code, modifier, and reimbursement limit — the fine print, but make it a movie poster.
No. 01
Individual & Family Therapy
H2019 · HR
Medicaid reimburses a maximum of 104 quarter-hour units (26 hours) of individual and family therapy services, per recipient, per state fiscal year. There is a maximum daily limit of four quarter-hour units (1 hour).
104 UNITS / FISCAL YEAR · 1 HR / DAY MAX
No. 02
Group Therapy
H2019 · HQ
Approved by Licensed Treating Practitioner
Medicaid reimburses a maximum of 156 quarter-hour units (39 hours) of group therapy services, per recipient, per state fiscal year.
156 UNITS / FISCAL YEAR
No. 03
Therapeutic Behavioral On-Site Services (TBOS)
H2019 · HO
Approved by Licensed Treating Practitioner
Medicaid reimburses therapeutic behavioral on-site therapy services a maximum combined limit of 36 15-minute units per month (9 hours) by a master’s level or certified behavioral analyst.
36 UNITS / MONTH
No. 04
Limited Functional Assessment (CFARS / FARS)
H0031
Medicaid reimburses a maximum of three limited functional assessments, per recipient, per state fiscal year — at admission, every six months, and at discharge.
3 / FISCAL YEAR · ADMIT · 6 MO · DISCHARGE
No. 05
Initial Treatment Plan Development
H0032
Reviewed & approved by Licensed Treating Practitioner
New and established patient. Medicaid reimburses the development of one treatment plan per provider, per state fiscal year, and a maximum total of two treatment plans per recipient per state fiscal year. The reimbursement date is the day the plan is authorized by the treating practitioner.
1 / PROVIDER · 2 / RECIPIENT · PER FISCAL YEAR
No. 06
Treatment Plan Review
H0032 · TS
Reviewed & approved by Licensed Treating Practitioner
Medicaid reimburses a maximum of four treatment plan reviews, per recipient, per state fiscal year. The reimbursement date for a review is the day it is authorized by the treating practitioner.
4 / FISCAL YEAR
PART TWO
Treating Licensed Counseling Practitioner
Dr. Franklin Edward Shoemaker, PhD, LMHC, QS, TF-CBT
No. 07
In-Depth Assessment — New Patient
H0031 · HO
Medicaid reimburses one in-depth assessment, per recipient, per state fiscal year. Not reimbursable on the same day for the same recipient as a bio-psychosocial evaluation.
1 / FISCAL YEAR
No. 08
In-Depth Assessment — Established Patient
H0031 · TS
Medicaid reimburses one in-depth assessment, per recipient, per state fiscal year. Not reimbursable on the same day for the same recipient as a bio-psychosocial evaluation.
1 / FISCAL YEAR
No. 09
Bio-Psychosocial Evaluation
H0031 · HN
Medicaid reimburses one bio-psychosocial evaluation, per recipient, per state fiscal year. Not reimbursable on the same day for the same recipient as an in-depth assessment.
1 / FISCAL YEAR
A bio-psychosocial evaluation is not reimbursable for the same recipient after an in-depth assessment has been completed, unless there is a documented change in the recipient’s status and additional information must be gathered to modify the recipient’s treatment plan.