In Florida, compassionate care for terminally ill patients requires not only medical expertise but also financial transparency and a robust payment system. The state Medicaid payment process can be challenging for hospice providers, especially when rates, billing rules, and regulations change each year.
That’s why it’s critical to understand the Florida Medicaid Hospice Fee Schedule 2026 so your organization can remain financially stable and continue to provide care to patients without interruption.
In this guide, we’ll explain the latest Florida Medicaid Hospice Fee Schedule 2026, simplify Medicaid billing codes, and highlight important policy changes that could impact Florida agencies.
What Is the Florida Medicaid Hospice Fee Schedule?
The Florida Medicaid Hospice Fee Schedule 2026 is a formal payment framework developed by the Florida Agency for Health Care Administration (AHCA). It is intended to govern the payment system for hospice services provided to Medicaid-eligible patients.
The schedule describes the approved rates, billing codes, coverage criteria, and documentation requirements that hospice agencies must follow to receive accurate and timely payments for end-of-life care.
Florida Medicaid Hospice Per Diem Rates 2026
Florida Medicaid hospice payments in 2026 are set on a per-day basis, with four distinct levels of care: Routine Home Care (RHC), Continuous Home Care (CHC), General Inpatient Care (GIP), and Inpatient Respite Care (IRC).
These new rates are effective on October 1, 2025, and will continue through September 30, 2026. The rates listed on the AHCA website are from the beginning of the year, so minor changes may not be reflected there. It is best to contact the AHCA office for the most up-to-date information.
Routine Home Care (RHC)
This is the most basic type of hospice service and is the one most commonly used. It applies when a patient is stable and receiving routine care in their home or nursing home.
Service Intensity Add-On (SIA)
The SIA is paid for the last seven days of a patient’s life. It covers visits by a registered nurse (G0299) and a social worker (G0155) on an hourly basis. Revenue codes 0551 and 0561 are used for these, and a maximum of four hours per day can be paid.
Continuous Home Care (CHC)
This service is provided when a patient’s condition suddenly deteriorates (i.e., in a crisis) and they require continuous nursing care at home. In this condition, at least 8 hours of nursing care are provided in 24 hours.
Inpatient Respite Care (IRC)
This is the only category that is designed to be based on the convenience of the caregiver rather than the patient’s condition. If the patient’s caregiver becomes tired or needs a little rest, the patient may be admitted to a hospital or nursing home for a while so that the family can get some comfort.
Florida Medicaid Hospice Rates 2026
| Level of Care | Revenue Code | 2026 Rate | Billing Unit | Key Limitations |
| Routine Home Care (Days 1–60) | 0651 | $224.84 | Per Diem | High-rate tier; resets each benefit period. |
| Routine Home Care (Day 61+) | 0651 | $178.80 | Per Diem | Low-rate tier applies continuously after day 60. |
| SIA – RN Visit (last 7 days) | 0551 / G0299 | $17.07 | Per 15-min unit | Combined 4-hr/day with G0155. |
| SIA – Social Worker Visit (last 7 days) | 0561 / G0155 | $17.07 | Per 15-min unit | Combined 4-hr/day with G0299. |
| Continuous Home Care | 0652 | $67.31 | Per hour | Minimum 8 hrs/day; majority must be nursing care. |
| Inpatient Respite Care | 0655 | $544.70 | Per diem | Maximum 5 consecutive days per respite episode. |
| General Inpatient Care | 0656 | $1,164.47 | Per diem | Requires documented uncontrolled symptoms. |
| Physician Services | 0657 | $28 – $55 | Per CPT/HCPCS code | Billed separately; not a per diem rate. |
| Room & Board – Nursing Facility | 0658 | $180 – $320 | Per diem | Varies by facility; billed by nursing home, not hospice. |
| Room & Board – ICF/IID | 0654 | $180–$320 | Per diem | Varies by facility type and location. |
| Bed Hold – Therapeutic Leave | 0182 | $180–$300 | Per diem | Max 16 days per state fiscal year. |
| Bed Hold – Hospitalization | 0185 | $180–$290 | Per diem | Max 8 days per hospitalization. |
Note: The rates AHCA publishes take effect on October 1st, the first day of the rate year. AHCA’s website is not updated for increases or decreases in rates. For individual updated rates, contact Medicaid Cost Reimbursement. SMMC providers should also verify their rates with their respective MCOs, as MCOs have the authority to negotiate higher rates than AHCA’s minimum rates.
Room & Board and Physician Services
Two categories fall outside the standard four levels of care but are billed under the hospice category:
Room and Board
When a patient is staying in a nursing home or ICF, the bill for their room and board is sent separately to Medicaid. The rate ranges from $180 to $320 per day, depending on the area. Remember that the hospice agency is only responsible for the treatment, while the nursing home handles the bill for living expenses.
Physician Services
Code 0657 is used for doctors’ examinations and consultations. It is paid according to the general physician fee schedule rather than a fixed daily rate, which usually ranges from $28 to $55. It is important to include the correct CPT or HCPCS code for the service with the bill.
Florida Medicaid Hospice Billing Codes 2026
For accurate billing, it is important to use the correct Florida Medicaid hospice billing codes. You should know how revenue codes, procedure codes, and modifiers work together so that your payment is not delayed under the Florida Medicaid hospice fee schedule 2026.
Here are some key points:
Revenue Codes
These codes tell you what type of service you provided to the patient. The core codes used in Florida Medicaid hospice services rate billing are:
| Revenue Code | Description |
| 0651 | Routine Home Care (RHC) |
| 0652 | Continuous Home Care (CHC) |
| 0655 | Inpatient Respite Care (IRC) |
| 0656 | General Inpatient Care (GIP) |
| 0657 | Physician Services |
| 0658 | Room & Board – Nursing Facility |
Remember, the code you write on the bill must match the patient’s medical record. If something happened in the record and something else happened on the bill, it could be a problem in the audit.
Procedure Codes (HCPCS)
Some services require a procedure code along with a revenue code. For example, G0299 is used for a nurse visit in the last 7 days of life and G0155 is used for a social worker. A CPT code is also required for the doctor’s fees.
Diagnosis Codes
The bill must include the actual disease code (ICD-10-CM) that led to the patient being in hospice. If the codes are incomplete, Medicaid may reject the bill, stating that the need for the treatment has not been proven.
Modifiers
These two modifiers are very important:
GV
When the doctor is not an employee of the hospice.
GW
When the service is not related to the disease being treated in the hospice.
2026 Updates and Policy Changes
Forgetting or misplacing often results in bills getting stuck and then having to make lengthy appeals. Staying up to date with Florida Medicaid Hospice Rates 2026 is not an option, but a necessity, as even a small change in policy can impact your cash flow and compliance with the law. Here are the key things every provider needs to know:
AHCA Rates for 2026
The new Florida Medicaid rates went into effect on October 1, 2025, and will run through September 30, 2026. These rates are set based on the federal budget and market conditions. If you are working under a Statewide Medicaid Managed Care (SMMC), it is best to confirm your rates directly with the relevant company (MCO), as their rates may vary slightly from the normal schedule.
Impact of Federal Laws
At the federal level, the CMS has made some changes to the wage index for 2026 that will directly affect Florida rates. This will be especially true for providers in expensive cities like Miami.
New Transparency Rules
By July 2026, AHCA must make all rates public records online. This will make it easier to check Florida Medicaid hospice services rates, but it will also increase the risk of audit because all billing details will now be in plain sight.
What Providers Should Do?
- Stay up to date by joining the AHCA email list to be notified of any new changes.
- Confirm your rates in writing before renewing your contract.
- Check your documentation to make sure your records of patient visits comply with the new rules.
- Do an internal audit. First, inspect large bills like GIP and CHC yourself, as they will be closely monitored in 2026.
It is better to be alert in advance so that the bill does not get rejected than to fix it afterwards.
Frequently Asked Questions (FAQs)
Q1: Does Florida’s Medicaid program include hospice?
Ans. Yes, Florida Medicaid does require hospice. It is available to all eligible individuals who meet the medical criteria.
Q2: What are the two criteria that a patient needs for hospice?
Ans. The first criterion is that the patient must be terminally ill and have a doctor’s diagnosis of 6 months or less to live. The second criterion is that the patient has decided to focus on comfort care rather than treatment.
Q3: What is the maximum income for Medicaid in Florida in 2026?
Ans. The Florida Medicaid eligibility criteria for most adults in 2026 is 138% of the federal poverty level (about $20,120 per year for a single person). However, financial requirements may be slightly different for hospice patients, such as a monthly income limit of about $2,982 for nursing home-level care.
Conclusion
The Florida Medicaid hospice fee schedule 2026 is essential for every provider to serve patients and run their organization properly. If you stay up to date with the new rates, billing codes, and AHCA rules, your bills will not be rejected and payments will be made on time.
There may be differences between fee-for-service and managed care rates, and patients who have both Medicare and Medicaid require special consideration. Keep your team trained on billing principles and check the official website for new rules every three months.