Florida Billing Guide for Mental Health Therapists and Psychiatrists
Who pays, where to enroll and which rules change your claims in Florida, for psychotherapists and psychiatric prescribers.
Last checked October 25, 2026. Reviewed against the official sources listed at the bottom of this page.
This Florida billing guide covers Medicaid, Medicare, Blue Cross, other private payers and state law for therapists and psychiatrists, with sources and a last-checked date.
Florida billing guide: how Florida pays for outpatient care
Florida Medicaid is run by the Agency for Health Care Administration (AHCA). Most members are in Statewide Medicaid Managed Care (SMMC), where behavioral health is a required service, so you bill the member's health plan. Gainwell Technologies is the fiscal agent for fee-for-service claims.
Community behavioral health services in Florida Medicaid are paid on a Florida-specific fee schedule that uses H and T codes with modifiers, not only the standard 908xx psychotherapy codes. Check which schedule applies to your service before you bill.
Who to bill, at a glance
| Payer type | Who you bill | Where to enroll or check rules |
|---|---|---|
| Medicaid | AHCA; SMMC health plans; Gainwell for fee-for-service | AHCA provider services |
| Medicare Part B | First Coast Service Options, Jurisdiction N | CMS MAC page |
| Blue Cross Blue Shield | Florida Blue (independent licensee) | See the Blue Cross section below |
Florida Medicaid: Florida Medicaid and Statewide Medicaid Managed Care
This Florida billing guide starts with Medicaid, because it decides who pays and how you file.
Florida Medicaid is mixed, mostly managed care. The SMMC 2025-2030 contracts define five plan types and specialty populations, including Serious Mental Illness. Fee-for-service claims go to the fiscal agent.
No behavioral health carve-out turned up in the sources we reviewed. AHCA lists assessments, medical and psychiatric services, individual, group and family therapy and rehabilitative services as minimum covered services for all Managed Medical Assistance plans.
| Item | What to know |
|---|---|
| Agency | Agency for Health Care Administration |
| Fiscal agent and portal | Gainwell Technologies, Florida Medicaid web portal |
| Fee schedules | AHCA Rule 59G-4.002 fee schedules |
| Community behavioral health fee schedule | 2026 Community Behavioral Health Fee Schedule |
| Fee-for-service filing window | Fee-for-service claims have a 12-month limit. Late claims may be allowed as exceptional claims through the secure portal's Claims panel with an Exceptional Claim Form. Source |
| Service limits | AHCA Policy Transmittal PT 2026-16, dated September 11, 2026, ends the requirement that plans waive frequency and duration limits for certain community behavioral health and targeted case management services. Plans must reinstate standard limits, effective about October 11, 2026. [Source](https://ahca.myflorida.com/file/medicaid/PT 2026-16 End of Reqs Established in PT 2022-01_09.11.26.pdf) |
Managed-care plans and carve-outs
| Plan or entity | Role in behavioral health |
|---|---|
| Sunshine State Health Plan | Operates the Children's Medical Services (CMS) Plan until October 1, 2026. |
| Molina Healthcare | Takes over the CMS Plan on October 1, 2026. Members move automatically and Molina honors existing authorizations. |
Check the AHCA SMMC plan list for the current plan roster by region before you contract.
Medicare Part B in Florida
For Medicare, this Florida billing guide names your contractor and the current telehealth rules.
Medicare Part B pays for outpatient psychotherapy and psychiatric visits billed to the Medicare Administrative Contractor (MAC) for your state. CMS's July 14, 2026 fact sheet on the CY2027 Physician Fee Schedule proposed rule says the Consolidated Appropriations Act, 2026 extended telehealth payment authority through December 31, 2027, and proposes that in-person visit requirements for mental health visits not apply to services furnished through that date.
| Item | What to know |
|---|---|
| Contractor | First Coast Service Options, Inc. |
| Jurisdiction | Jurisdiction N: Florida, Puerto Rico and the U.S. Virgin Islands |
| Source | CMS.gov MAC page |
Blue Cross Blue Shield in Florida
This part of the Florida billing guide names the exact Blue Cross licensee, because Blue plans never share rules.
Blue Cross Blue Shield is a federation of independent companies, so one licensee's rules never apply to another. In Florida that is Florida Blue (Blue Cross and Blue Shield of Florida). Florida Blue provider notices identify it as an independent licensee of the Blue Cross and Blue Shield Association. It is not Anthem, and its rules do not apply to other Blue plans.
| Licensee | Parent or affiliation | Where it applies | Provider resources |
|---|---|---|---|
| Florida Blue (Blue Cross and Blue Shield of Florida) | Independent licensee of the Blue Cross and Blue Shield Association | Florida | Florida Blue provider news |
Other private payers and EAPs in Florida
The Florida billing guide also covers commercial plans and employee assistance programs.
These commercial payers and plan families most often matter for behavioral health billing in Florida. Check each payer's current provider manual before you submit.
| Payer | Behavioral health note | Provider resources |
|---|---|---|
| Florida Blue behavioral health | A 2023 Florida Blue provider notice says Lucet (formerly New Directions Behavior Health) manages behavioral health for myBlue members. Confirm the current vendor arrangement before you bill. | Official page |
| Florida Blue prolonged services | A January 2022 notice says to use HCPCS G2212 instead of CPT 99417 for prolonged behavioral health services, and that 99417 claims deny. Confirm the current policy. | Official page |
Florida billing guide: state law that changes billing
Use this section of the Florida billing guide to separate state law from payer policy.
State law sets the floor for commercial plans in Florida. Medicare and Medicaid rules are covered in their own sections above.
Telehealth contracts
Florida Statute 627.42396 says insurer-provider telehealth contracts must be voluntary and set mutually acceptable rates. A contract term that pays telehealth differently from the same service without telehealth must be initialed by the telehealth provider. The section does not itself require equal payment. Statute
Prompt payment and timely filing
Florida Statute 627.6131 requires insurers to pay, deny or contest electronic claims within 20 days and paper claims within 40 days. Overdue payment bears simple interest at 12% a year. Claims go to the primary insurer within 6 months of the date of service once the correct insurer is known, and secondary claims within 90 days of the primary determination. Statute
Prescribers
Federal DEA telemedicine controlled-substance flexibilities were extended through December 31, 2026. Confirm the status with the DEA before you rely on it.
Not legal advice. Confirm statute details with counsel.
Florida billing guide: codes and rates
This Florida billing guide lists only codes and rates confirmed on official pages.
These are the Florida-specific codes, modifiers and rate items confirmed on official pages. Medicare's own CY2027 conversion factor proposal is listed under What changed.
| Code or item | What to know |
|---|---|
| Community behavioral health codes | The 2026 fee schedule uses H and T codes with modifiers. Examples: H2000 with HP, $250.63, and H2000 with HO, $179.02. Check the schedule for modifier definitions and unit limits. Source |
| Standard psychotherapy and E/M codes | Use the 2026 Practitioner Fee Schedule for 908xx psychotherapy and E/M rates. Source |
| G2212 instead of 99417 (Florida Blue) | Florida Blue January 2022 notice: use G2212 for prolonged behavioral health E/M. Source |
Florida billing guide: what changed, newest first
Check this Florida billing guide update log before you rely on an older rule.
| Date | What changed | Source |
|---|---|---|
| 2026-10-01 | Children's Medical Services Plan moves from Sunshine State Health Plan to Molina Healthcare. | Source |
| 2026-09-11 | AHCA PT 2026-16 ends the service-limit waiver for certain community behavioral health services. | [Source](https://ahca.myflorida.com/file/medicaid/PT 2026-16 End of Reqs Established in PT 2022-01_09.11.26.pdf) |
| 2026-07-14 | CMS released the CY2027 Medicare Physician Fee Schedule proposed rule: conversion factor $32.84 for non-qualifying APM participants (down 1.68%) and $33.17 for qualifying participants (down 1.19%). | Source |
| 2026-07-01 | AHCA SMMC Attachment I Scope of Services, July 2026, lists behavioral health integration and collaborative care. | [Source](https://ahca.myflorida.com/file/medicaid/Health_Attachment I - Scope of Services_July 2026.pdf) |
| 2026-06-01 | CMS issued the Medicaid community engagement interim final rule. States generally implement by 1/1/2027 for covered adults. | Source |
| 2026-01-01 | AHCA updated the Practitioner and Community Behavioral Health fee schedules. | Source |
How do I bill mental health claims in Florida?
These answers come from the same sources as the rest of this Florida billing guide.
Start with the member's payer type. For Florida Medicaid managed care, bill the member's SMMC plan. For fee-for-service, use the Gainwell portal. Medicare Part B goes to First Coast Service Options in Jurisdiction N. Florida Blue is the Blue licensee for commercial members and is independent, not Anthem.
Questions about billing in Florida
Who do I bill for Florida Medicaid behavioral health claims?
For managed care members, bill the member's SMMC plan. For fee-for-service, bill through the Gainwell portal.
Is Florida Blue the same as Anthem?
No. Florida Blue is an independent licensee of the Blue Cross and Blue Shield Association. Its rules do not apply to other Blue plans.
What is the Florida Medicaid fee-for-service filing limit?
Fee-for-service claims have a 12-month limit, with exceptional claims allowed in some cases through the secure portal.
What changed for Florida Medicaid behavioral health limits in 2026?
AHCA Policy Transmittal PT 2026-16 ends the requirement that plans waive frequency and duration limits for certain community behavioral health services. Standard limits return about October 11, 2026.
Does MCM South bill for practices in Florida?
MCM South serves Florida. Request a quote to talk through your practice.
Sources for the Florida billing guide
Last checked October 25, 2026. Every source below was opened and read on that date.
- AHCA Medicaid provider services, checked October 25, 2026
- AHCA fee schedules, Rule 59G-4.002, checked October 25, 2026
- AHCA 2026 Community Behavioral Health Fee Schedule, checked October 25, 2026
- AHCA Policy Transmittal PT 2026-16, checked October 25, 2026
- AHCA CMS Plan transition, checked October 25, 2026
- CMS: MAC Jurisdiction N, checked October 25, 2026
- Florida Blue provider news, August 2023, checked October 25, 2026
- Florida Statute 627.42396, checked October 25, 2026
- Florida Statute 627.6131, checked October 25, 2026
- CMS fact sheet: Medicaid community engagement rule, checked October 25, 2026
- CMS: CY2027 Physician Fee Schedule proposed rule fact sheet, checked October 25, 2026
- CMS MAC jurisdiction page, checked October 25, 2026
Related guides
- State & Regional Billing Guides hub
- Florida insurance companies contact guide
- In-network vs out-of-network credentialing
- Credentialing and network status
- Blue Cross Blue Shield guide for Florida
- Florida Medicaid billing codes
- Mental health parity explained
- Medicaid managed care billing
- Medicare behavioral health billing
- Timely filing in the billing glossary
- Who we serve
- Georgia insurance companies contact guide
Billing in Florida? Let us handle the payer calls.
MCM South bills only mental and behavioral health, for psychotherapists and psychiatrists, in solo and medium-size practices. We serve Florida.
MCM South currently serves practices in ten states: Georgia, Massachusetts, Connecticut, Texas, Florida, New York, Colorado, Tennessee, North Carolina and Illinois.