32. Radiology Fee Schedule 2020 Excel · 2020-02-25 · 7&, lqglfdwhv wkh whfkqlfdo frpsrqhqw lqfuhdvh iru wkh whfkqlfdo SRUWLRQ L H VWDII DQG HTXLSPHQW FRVWV RI D WHVW 3$ LQGLFDWHV

Legend

Pediatric Rate Increases for Recipients (ages 0-20 years)

Note

• 4% increase for all FSI, Facility, PCI, and TCI rates for all services. Example: (FSI, Facility, PCI, or TCI) X 1.04 = rate with 4% increase.

• 24% increase for all FSI, Facility, PCI, and TCI rates for all services with physician specialty types: 02, 03, 04, 05, 08, 10, 14, 15, 17, 21, 22, 23, 29, 30, 31, 36, 37, 38, 39, 43, 46, 51, 53, 55, 57, 58, 60, and 62. Example: (FSI, Facility, PCI, or TCI) X 1.04 X 1.24 = rate with 4% and 24% increases.

• Procedure: indicates the service level code reimbursed in the fee-for-service delivery system within the practitioner’s scope of practice.

• Modifier (Mod): indicates pricing modifiers that have alerted the code by some circumstance without significantly changing the base definition.

• Fee Schedule Increase (FSI): indicates the base Florida Medicaid rate with a 4% increase included for all ages and certain provider types (independent of increases detailed above). Provider types include (25, 26, 27, 28, 29, 30, 35, and 62 .

• PCI: indicates the professional component increase for physician work portion of a test.

• TCI: indicates the technical component increase for the technical portion (i.e. staff and equipment costs) of a test.

• PA: indicates the need for a prior authorization of the service through the Agency’s Quality Improvement Organization vendor.

Reimbursement increases noted above do not apply to the following services: Regional Perinatal Intensive Care Center services, injectable medications, immunizations, supplies, devices, portable x-ray, and laboratory/pathology services.

Radiology Fee Schedule2020

Page 1

Procedure Mod FSI PCI TCI PA70010 56.9070015 91.19 38.49 52.7070030 15.14 4.18 10.9670100 18.05 4.56 13.4970110 20.77 6.28 14.4970120 19.64 4.96 14.6870130 29.89 8.72 21.1770134 27.92 9.75 18.1770140 16.31 5.37 10.9370150 22.71 6.69 16.0270160 17.86 4.38 13.4870170 39.40 7.88 31.5270190 20.73 6.14 14.5970200 23.10 7.05 16.0570210 16.31 4.69 11.6270220 20.58 6.39 14.1970240 16.72 4.98 11.7470250 19.79 5.74 14.0570260 25.04 8.28 16.7670300 8.87 3.62 5.2570310 23.05 5.13 17.9170320 28.30 5.99 22.3170328 17.83 4.93 12.9070330 25.90 6.25 19.6570332 39.45 13.27 26.1970336 172.83 41.81 131.02 Y70350 11.15 5.92 5.2370355 11.45 6.36 5.0970360 15.33 4.64 10.7070370 42.08 7.10 34.9870380 20.32 5.44 14.8970390 56.14 11.61 44.5470450 64.01 23.83 40.18 Y70460 90.12 31.41 58.70 Y70470 105.52 35.31 70.22 Y70480 104.49 33.53 70.95 Y70481 151.00 38.41 112.59 Y70482 164.77 42.32 122.46 Y70486 82.74 25.75 56.99 Y70487 100.55 34.23 66.32 Y70488 122.63 38.52 84.11 Y70490 92.80 36.48 56.32 Y70491 112.02 38.52 73.50 Y70492 134.90 45.23 89.67 Y70496 195.45 58.05 137.40 Y70498 196.47 58.42 138.04 Y70540 159.90 41.39 118.51 Y70542 193.09 51.15 141.94 Y


Radiology Fee Schedule 2020 2 / 15

Procedure Mod FSI PCI TCI PA


70543 222.33 61.46 160.86 Y70544 177.02 43.61 133.40 Y70545 195.56 46.11 149.45 Y70546 265.45 53.55 211.90 Y70547 176.58 43.57 133.01 Y70548 185.01 50.91 134.10 Y70549 276.13 64.44 211.69 Y70551 166.28 55.87 110.41 Y70552 182.18 53.04 129.14 Y70553 219.15 69.35 149.80 Y70555 348.00 69.60 278.40 Y70557 402.85 80.57 322.28 Y70558 442.75 88.55 354.20 Y70559 445.65 89.13 356.52 Y71045 11.06 4.00 7.0771046 16.85 5.68 11.1771047 21.46 7.22 14.2571048 23.01 8.40 14.6171100 18.05 5.77 12.2771101 19.98 6.60 13.3871110 20.58 7.14 13.4471111 26.04 8.32 17.7271120 16.11 5.08 11.0371130 18.82 5.38 13.4471250 89.91 33.14 56.78 Y71260 108.22 34.70 73.52 Y71270 129.55 38.69 90.86 Y71275 165.22 49.97 115.25 Y71550 186.10 34.69 151.42 Y71551 268.31 53.40 214.91 Y71552 308.34 62.93 245.40 Y71555 219.60 51.60 168.00 Y72020 12.04 4.07 7.9772040 18.05 5.40 12.6572050 24.84 6.82 18.0272052 30.66 7.90 22.7772070 18.63 6.07 12.5672072 18.82 5.75 13.0772074 21.35 6.18 15.1772080 16.69 5.39 11.3072081 21.35 6.93 14.4272082 34.15 8.27 25.8972083 37.07 8.72 28.3572084 44.05 9.92 34.1372100 19.22 5.75 13.4772110 26.78 7.29 19.4972114 33.94 8.74 25.2072120 22.13 6.38 15.75




72125 93.83 30.42 63.41 Y72126 125.37 39.43 85.93 Y72127 148.30 41.19 107.11 Y72128 92.09 29.86 62.24 Y72129 125.95 39.33 86.62 Y72130 148.47 41.18 107.29 Y72131 92.09 29.99 62.10 Y72132 125.37 39.36 86.01 Y72133 147.70 40.99 106.71 Y72141 147.64 50.98 96.65 Y72142 183.80 52.57 131.23 Y72146 148.26 51.20 97.06 Y72147 178.51 51.21 127.31 Y72148 146.44 50.49 95.95 Y72149 181.57 52.56 129.01 Y72156 218.33 68.56 149.77 Y72157 209.94 65.80 144.15 Y72158 215.20 67.70 147.49 Y72159 250.84 57.23 193.61 Y72170 17.46 5.46 12.0072190 20.77 6.56 14.2172191 168.44 47.12 121.32 Y72192 80.53 30.32 50.21 Y72193 123.82 29.82 94.00 Y72194 142.90 32.27 110.63 Y72195 172.51 47.91 124.61 Y72196 197.80 55.68 142.13 Y72197 234.60 66.17 168.42 Y72198 220.33 51.13 169.20 Y72200 15.53 4.31 11.2172202 18.05 5.57 12.4872220 15.33 4.36 10.9872240 61.86 29.16 32.7072255 62.23 29.98 32.2672265 54.40 21.76 32.6472270 74.95 35.79 39.1672275 63.27 19.20 44.0772285 68.70 37.26 31.4472295 51.98 20.82 31.1573000 15.14 4.13 11.0173010 16.49 5.50 10.9973020 12.62 4.63 7.9973030 15.91 4.62 11.2973040 54.73 12.59 42.1473050 19.40 5.95 13.4573060 15.91 4.34 11.5773070 14.95 4.48 10.4673080 17.07 4.91 12.17




73085 54.55 14.24 40.3173090 14.17 4.20 9.9773092 15.12 4.09 11.0373100 15.91 4.15 11.7673110 19.35 4.44 14.9173115 62.21 13.98 48.2373120 14.36 4.05 10.3073130 16.89 4.31 12.5873140 17.27 3.45 13.8273200 92.09 26.00 66.09 Y73201 121.89 31.93 89.95 Y73202 152.53 33.74 118.79 Y73206 179.88 49.45 130.43 Y73218 169.95 32.86 137.09 Y73219 236.68 50.01 186.67 Y73220 273.85 61.76 212.09 Y73221 153.63 46.30 107.32 Y73222 207.08 46.69 160.39 Y73223 257.54 61.55 195.99 Y73225 209.74 46.55 163.19 Y73501 16.31 4.95 11.3673502 22.71 5.72 16.9973503 28.33 7.04 21.2973521 20.69 5.91 14.7873522 26.78 7.70 19.0873523 31.05 8.42 22.6373525 59.51 14.41 45.1073551 15.33 4.49 10.8473552 17.86 4.79 13.0773560 16.89 4.31 12.5773562 19.60 4.81 14.7973564 21.74 5.66 16.0973565 19.60 4.50 15.1073580 62.31 13.31 49.0073590 15.72 4.20 11.5173592 14.54 3.93 10.6073600 16.31 4.40 11.9173610 17.27 4.41 12.8673615 55.15 12.68 42.4773620 14.17 4.00 10.1773630 15.91 4.15 11.7673650 14.75 4.29 10.4673660 15.33 3.69 11.6473700 92.09 29.99 62.10 Y73701 123.82 37.26 86.56 Y73702 150.51 39.46 111.05 Y73706 189.00 50.27 138.72 Y73718 168.85 44.48 124.37 Y




73719 181.50 48.87 132.63 Y73720 234.08 64.60 169.49 Y73721 156.86 46.77 110.10 Y73722 208.82 46.99 161.83 Y73723 257.73 61.69 196.04 Y73725 220.51 51.68 168.83 Y74018 15.12 4.79 10.3274019 18.39 6.01 12.3874021 21.60 7.02 14.5974022 24.45 8.09 16.3674150 82.79 33.31 49.48 Y74160 126.90 33.00 93.90 Y74170 144.38 36.60 107.78 Y74174 197.04 53.58 143.46 Y74175 169.07 47.75 121.32 Y74176 110.24 48.37 61.88 Y74177 170.60 47.97 122.62 Y74178 191.95 52.67 139.28 Y74181 155.37 50.97 104.39 Y74182 210.68 52.35 158.33 Y74183 235.18 66.22 168.96 Y74185 220.87 51.22 169.65 Y74190 64.75 12.95 51.8074210 40.73 12.86 27.8674220 48.34 15.16 33.1774221 69.16 22.37 46.7874230 57.21 11.79 45.4274240 61.71 20.93 40.7874246 69.47 22.80 46.6774248 52.43 22.37 30.0674250 56.81 19.32 37.4874251 191.09 28.05 163.0574270 82.10 27.81 54.2974280 116.83 33.33 83.5074283 107.52 45.16 62.3674290 38.90 8.32 30.5874300 52.36 10.47 41.8974301 29.00 5.80 23.2074328 102.71 20.54 82.1774329 98.60 19.72 78.8874330 130.90 26.18 104.7274340 74.45 14.89 59.5674355 99.35 19.87 79.4874360 80.56 16.11 64.4474363 117.95 23.59 94.3674400 60.28 11.55 48.7374410 66.37 15.11 51.2674415 79.82 12.87 66.95




74420 44.11 15.27 28.8474425 47.13 9.14 37.9974430 23.71 9.44 14.2774440 49.83 11.50 38.3374445 146.80 29.36 117.4474450 45.45 9.09 36.3674455 44.83 7.53 37.3174470 72.50 14.50 58.0074485 50.89 18.19 32.7074710 20.07 8.78 11.2974712 206.26 65.66 140.60 Y74713 121.11 49.31 71.80 Y74740 40.95 8.71 32.2474742 79.65 15.93 63.7275557 181.41 66.04 115.37 Y75559 277.03 89.24 187.79 Y75561 238.88 72.96 165.92 Y75563 295.92 88.14 207.78 Y75565 30.00 7.09 22.90 Y75571 50.96 14.16 36.79 Y75572 148.32 52.05 96.27 Y75573 204.22 77.75 126.47 Y75574 201.91 66.77 135.14 Y75600 103.60 13.02 90.5875605 75.68 32.17 43.5175625 75.30 38.23 37.0775630 93.36 53.76 39.5975635 202.38 54.28 148.10 Y75705 128.19 59.85 68.3575710 88.89 47.04 41.8575716 102.28 56.11 46.1775726 81.91 43.79 38.1275731 90.56 31.89 58.6775733 106.98 38.96 68.0275736 87.72 31.79 55.9475741 82.93 36.83 46.0975743 93.69 46.95 46.7475746 83.88 32.36 51.5375756 96.34 33.16 63.1975774 47.75 21.67 26.0775801 127.88 25.58 102.3075803 161.45 32.29 129.1675805 105.65 21.13 84.5275807 162.40 32.48 129.9275809 54.15 14.12 40.0375810 157.60 31.52 126.0875820 63.27 20.40 42.8875822 75.10 31.01 44.09




75825 74.33 32.87 41.4675827 75.88 32.49 43.3975831 78.00 32.46 45.5375833 92.36 42.76 49.6175840 93.62 36.95 56.6775842 112.34 48.26 64.0875860 75.27 30.77 44.5175870 84.97 29.75 55.2275872 102.91 40.62 62.2975880 79.07 22.62 56.4575885 88.78 40.70 48.0875887 86.79 39.91 46.8775889 78.79 31.64 47.1575891 79.90 32.21 47.6975893 65.23 15.45 49.7875894 195.35 39.07 156.2875898 231.05 46.21 184.8475901 97.04 10.57 86.4675902 39.48 8.88 30.6075956 967.70 193.54 774.1675957 830.40 166.08 664.3275958 551.05 110.21 440.8475959 463.70 92.74 370.9675970 110.20 22.04 88.1675984 58.02 20.59 37.4375989 63.35 30.66 32.6976000 30.07 11.21 18.8676010 14.36 4.61 9.7576080 30.28 13.42 16.8676098 9.13 3.39 5.7376100 54.19 17.34 36.8576101 85.77 24.75 61.0276102 98.82 17.73 81.0976120 47.40 8.36 39.0376125 36.70 7.34 29.3676376 20.24 8.72 11.5276377 39.21 21.83 17.3876380 66.16 22.27 43.89 Y76390 211.91 35.38 176.53 Y76496 Y76497 Y76498 Y76499 Y76506 65.17 18.25 46.9376510 76.22 39.90 36.3276511 48.26 28.13 20.1376512 41.60 24.85 16.7576513 52.21 18.95 33.26




76514 8.35 5.65 2.7076516 35.25 16.85 18.4076519 40.93 19.16 21.7776529 47.66 19.68 27.9876536 64.25 15.72 48.5376604 48.72 17.91 30.8076641 58.16 19.84 38.3376642 47.90 18.62 29.2876700 67.54 22.58 44.9676705 50.46 16.30 34.1676706 55.16 13.40 41.7676770 62.49 20.37 42.1276775 37.28 18.42 18.8776776 86.56 21.39 65.1776800 78.79 32.38 46.4276801 68.32 27.92 40.4076802 35.72 23.48 12.2476805 78.79 28.13 50.6776810 51.63 27.91 23.7276811 101.70 54.40 47.3076812 113.92 50.97 62.9576813 67.73 33.07 34.6676814 45.02 28.39 16.6376815 46.97 18.23 28.7476816 64.25 24.17 40.0876817 53.96 21.18 32.7876818 68.52 30.45 38.0676819 50.08 22.28 27.8076820 25.06 13.48 11.5876821 51.63 19.84 31.7976825 136.13 41.14 94.9976826 82.05 20.78 61.2776827 37.16 14.54 22.6276828 27.56 14.81 12.7576830 67.54 19.08 48.4776831 66.18 20.09 46.0976856 60.94 19.13 41.8176857 32.70 16.71 15.9976870 42.64 12.97 29.6876872 52.40 11.24 41.1676873 94.32 42.22 52.1076881 56.23 22.85 33.3876882 19.79 8.48 11.3176885 66.21 17.17 49.0576886 51.16 15.16 36.0076932 93.65 18.73 74.9276936 145.45 52.88 92.5876937 17.27 6.87 10.40




76940 284.20 56.84 227.3676941 188.50 37.70 150.8076942 70.10 38.94 31.1576945 100.69 20.14 80.5676946 18.05 10.51 7.5476965 50.76 37.11 13.6576975 116.95 23.39 93.5676977 3.99 1.59 2.3976998 182.26 36.45 145.8076999 Y77001 46.41 9.08 37.3377002 49.07 12.71 36.3677003 40.31 12.02 28.2977011 241.47 66.52 174.95 Y77012 68.12 33.58 34.54 Y77013 537.50 107.50 430.00 Y77014 66.19 24.56 41.64 Y77021 225.35 35.61 189.74 Y77022 583.90 116.78 467.12 Y77046 150.43 44.91 105.52 Y77047 154.51 49.54 104.97 Y77048 238.93 64.92 174.01 Y77049 244.07 71.11 172.97 Y77053 32.65 10.41 22.2477054 43.00 13.29 29.7177063 30.47 16.71 13.7677065 67.45 20.70 46.7577066 85.71 25.57 60.1477067 70.25 19.84 50.4177071 26.5977072 12.62 4.80 7.8277073 19.60 6.16 13.4477074 35.32 12.50 22.8277075 47.74 14.07 33.6677076 52.90 18.06 34.8477077 20.39 7.74 12.6477078 61.54 6.69 54.85 Y77080 22.52 5.68 16.8477081 15.33 4.89 10.4577084 223.06 48.62 174.44 Y77085 30.04 8.41 21.6377086 18.46 4.57 13.8977261 40.3577262 60.8977263 91.4177280 111.08 15.14 95.9477285 196.47 24.65 171.8177290 284.12 47.62 236.50




77293 251.99 59.79 192.2077295 270.15 126.07 144.0877300 36.68 18.15 18.5477301 1,075.97 238.86 837.1177306 77.36 38.59 38.7777307 151.48 80.54 70.9477316 99.22 33.93 65.2977317 129.82 44.45 85.3777318 187.61 70.54 117.0777321 51.25 27.73 23.5277331 35.32 25.15 10.1877332 32.79 16.64 16.1577333 30.74 10.19 20.5577334 71.92 34.67 37.2677336 26.9477338 279.47 130.61 148.8677370 67.1577371 593.7277372 481.6677373 750.1177385 130.4277386 151.6577387 45.0377399 Y77401 12.6577402 84.8877407 118.8977412 126.4177417 6.0177423 151.6577427 102.2877431 56.2877432 230.3877435 347.2177470 76.33 61.83 14.5077499 Y77520 712.03 Y77522 731.18 Y77523 699.39 Y77525 669.40 Y77600 243.63 37.55 206.0877605 409.38 50.15 359.2377610 445.52 38.93 406.5977615 589.86 54.73 535.1377620 264.30 37.26 227.0477750 208.42 143.41 65.0177761 228.53 115.47 113.0777762 283.01 161.85 121.16




77763 455.60 277.21 178.3977767 126.21 29.60 96.6177768 197.67 41.05 156.6277770 176.61 54.60 122.0177771 328.97 110.50 218.4777772 479.22 151.12 328.1177778 451.12 241.54 209.5877789 74.66 36.90 37.7677790 36.2977799 Y78012 45.61 5.29 40.3378013 103.22 9.59 93.6378014 137.22 13.80 123.4278015 127.40 18.62 108.7778016 168.50 19.86 148.6478018 168.99 22.07 146.9378020 45.10 15.03 30.0678070 103.05 13.37 89.6978071 193.78 31.79 161.9978075 239.09 19.58 219.5178099 Y78102 91.67 14.12 77.5578103 120.74 19.26 101.4978104 147.91 22.90 125.0078110 52.74 5.22 47.5378111 50.23 6.06 44.1778120 49.66 6.31 43.3578121 49.17 7.59 41.5878122 54.76 11.95 42.8178130 88.31 16.00 72.3178135 184.84 16.88 167.9678140 72.98 16.00 56.9878185 111.02 10.72 100.3078191 88.31 16.00 72.3178195 202.24 32.88 169.3678199 Y78201 97.32 10.69 86.6278202 96.14 11.12 85.0278215 110.24 13.41 96.8378216 70.60 14.73 55.8778226 187.86 20.63 167.2478227 254.82 25.54 229.2778230 103.20 13.48 89.7278231 68.14 13.80 54.3478232 53.78 10.18 43.6178258 112.66 18.02 94.6478261 122.23 17.16 105.0778262 117.87 16.32 101.55




78264 182.26 21.06 161.2078265 214.84 26.14 188.7078266 273.91 31.15 242.7678267 9.8078268 84.5078278 163.99 22.86 141.1278282 49.25 9.85 39.4078290 180.75 18.00 162.7578299 Y78300 102.87 13.80 89.0778305 125.21 18.43 106.7878306 142.65 20.02 122.6278315 196.40 28.34 168.0678350 17.98 5.73 12.2578399 Y78414 59.10 11.82 47.2878428 96.11 19.40 76.7178429 193.35 53.56 Y78430 146.47 50.85 Y78431 146.47 59.21 Y78432 195.30 63.06 Y78433 97.65 68.93 Y78434 146.47 19.89 Y78445 96.23 12.70 83.5378451 170.16 33.57 136.5878452 267.43 44.61 222.8378453 148.05 24.10 123.9478454 129.55 19.71 109.8478456 188.07 29.21 158.8678457 113.74 22.87 90.8778458 104.34 22.89 81.4578459 193.35 38.67 154.68 Y78466 105.75 18.49 87.2678468 119.15 23.52 95.6378469 126.64 25.37 101.2778472 129.65 27.28 102.3678473 163.42 39.77 123.6578481 100.53 27.38 73.1578483 147.73 42.78 104.9578491 195.30 39.06 156.24 Y78492 245.55 49.11 196.44 Y78494 121.31 30.94 90.3778496 26.34 14.78 11.5678499 Y78579 107.89 13.69 94.2078580 116.71 17.76 98.9578582 190.01 29.68 160.3378597 98.43 17.15 81.28




78598 166.21 22.16 144.0478599 Y78600 95.76 11.29 84.4778601 121.89 13.96 107.9378605 113.14 14.86 98.2878606 173.75 16.36 157.3978608 1,150.50 39.44 1,111.06 Y78609 1,146.79 40.66 1,106.13 Y78610 92.31 7.80 84.5178630 183.54 18.05 165.4978635 188.95 17.02 171.9378645 151.26 12.71 138.5478650 165.19 15.28 149.9178660 112.65 15.99 96.6678699 Y78700 93.16 11.81 81.3578701 122.03 13.28 108.7578707 131.97 26.35 105.6178708 99.56 32.86 66.7078709 206.89 38.03 168.8678725 57.81 9.51 48.3078730 43.75 4.50 39.2478740 106.16 13.16 93.0078761 112.92 18.82 94.1078799 Y78800 99.04 12.18 86.8678801 139.89 17.72 122.1678802 176.08 21.49 154.5978803 193.89 25.98 167.9178804 321.39 23.84 297.5578808 23.3478811 1,150.50 42.34 1,108.16 Y78812 1,265.55 56.78 1,208.77 Y78813 1,266.96 55.94 1,210.93 Y78814 1,151.78 59.55 1,092.23 Y78815 1,036.60 58.99 977.62 Y78816 1,151.78 66.12 1,085.66 Y78830 317.99 46.11 271.89 Y78831 459.92 56.28 403.65 Y78832 598.47 65.54 532.92 Y78835 66.67 14.46 52.2178999 Y79005 75.68 48.27 27.4279101 79.38 52.36 27.0279200 84.58 52.39 32.1979300 208.60 41.72 166.8879403 109.89 62.83 47.0679440 78.27 52.39 25.88




79445 316.10 63.22 252.8879999 YA4641 YA9500 150.00A9502 143.66A9505 71.37A9552 150.00A9600 879.75 YA9699 YR0070 21.83


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32. Radiology Fee Schedule 2020 Excel · 2020-02-25 · 7&, lqglfdwhv wkh whfkqlfdo frpsrqhqw lqfuhdvh iru wkh whfkqlfdo SRUWLRQ L H VWDII DQG HTXLSPHQW FRVWV RI D WHVW 3$ LQGLFDWHV