Billing for hospice services differs from almost any other part of the revenue cycle. Instead of billing for individual procedures, the agency receives a daily payment for each day the patient remains enrolled in the program; this amount depends on the level of care provided that day. For agencies serving Medicaid beneficiaries in Florida, the landscape includes an additional component: the state’s Agency for Health Care Administration (AHCA) publishes its own billing codes, limits, and documentation specifying the rates applicable to each provider. This guide details Florida Medicaid codes for hospice services, explains how payment is structured, and outlines the correct procedure for verifying your rate for the year 2026.

Who Sets Florida Medicaid Hospice Rates?

Medicaid hospice payments in Florida are based on a federal formula. Each year, CMS issues a memorandum containing national Medicaid hospice rates, which are calculated using annual Medicare rates. These rates take effect on October 1 and remain in effect until September 30 of the following year. Subsequently, the AHCA applies the formula to each hospice provider and issues provider-specific rate letters and spreadsheets, as the labor-related portion of the payment is adjusted based on the wage index for the area where the facility operates.

This detail is significant. Two hospice providers in Florida may receive different daily payment amounts for the same level of care; therefore, any single "Florida hospice rate" found on a third-party website should be considered, at best, an approximation. Your specific AHCA rate letter is the document that governs your reimbursement.

Florida Medicaid Hospice Revenue Codes for 2026

The AHCA’s list of billing codes for hospice care for 2026 identifies the revenue codes that Florida Medicaid recognizes for such services. A practical summary is provided below:

Always verify the list against the current AHCA document before creating or updating your billing templates, as codes and limits may vary from year to year.

Understanding the Four Levels of Care

Routine home care (0651) is the most common level of care and is reimbursed on a per-diem basis for each day the patient remains enrolled in the program, provided that no other level of care applies. Florida utilizes a two-tiered structure: a higher daily rate for the first 60 days of enrollment in the hospice program, and a lower rate from day 61 onwards. Since the day count is tied to enrollment, maintaining accurate records is essential; a discharge followed by a readmission may alter the applicable rate.

Continuous home care (0652) is reimbursed on an hourly basis and is intended for brief periods of crisis, during which the provision of intensive nursing care at home prevents the patient from requiring admission to a hospital or care facility. In accordance with the Medicare structure which Medicaid also follows—continuous care requires a significant minimum number of hours of assistance per day, the majority of which must consist of nursing care. Payment is justified through documentation of the crisis and the hours of care actually provided.

Respite care in a facility (0655) offers family caregivers a brief respite by transferring the patient to an authorized facility; this option is limited to short-term stays. General inpatient care (0656) is indicated for symptoms that cannot be managed in any other setting and carries the highest daily rate of the four levels of care. In both instances, it is necessary to thoroughly document the reasons why such a setting was clinically necessary.

The Service Intensity Add-On (SIA)

Florida Medicaid covers additional visits—referred to as "Service Intensity Add-on" (SIA)—beyond routine home care during the final seven days of an eligible patient's life. The two types of visits that may be reported are: registered nurse visits (code 0551 with G0299) and medical social worker visits (code 0561 with G0155). Billing is subject to several rules:

1. Services are recorded in 15-minute units.
2. Hours for registered nursing and social work are combined, but the total cannot exceed four hours per day.
3. Hours provided simultaneously are counted separately.
4. Reimbursement is tied to the hourly rate for continuous home care.

The seven-day period presents a documentation challenge, as the date of death determines which visits qualify. Many agencies hold claims for Service Intensity Add-on (SIA) services until the patient's death is confirmed; they then verify the visits against the calendar before submitting the claims.

Room and Board and Bed Holds

When a patient receiving hospice care resides in a long-term care facility (nursing home), the hospice provider typically bills for room and board under revenue code 0658 and, in accordance with their contract, transfers the payment to the facility in question. Generally, federal Medicaid regulations stipulate that the payment for room and board for residents of these facilities when they are receiving hospice care is equal to 95% of the facility’s own established rate. The AHCA publishes these room and board rates in specific documents; the most recent version includes changes that take effect on October 1, 2026, so you must verify the version that corresponds to the dates of service indicated on your claim.

Bed-hold codes (0182, 0184, 0185) are used to reserve a resident’s place during absences for therapeutic reasons or hospital stays; each of these is subject to a strict limit on the number of days allowed. Exceeding this limit is a common reason for the denial of these billed items.

Reference Rates: Where the National Numbers Stand

Since Florida’s rates are derived from federal rates for hospice care services, the annual Medicare update serves as a useful benchmark for payment trends. For fiscal year 2027, which began on October 1, 2026, the Centers for Medicare & Medicaid Services (CMS) established a 2.3 percent payment update. The national base rates, prior to adjustment for the wage index, are as follows:

Consider these values ​​as benchmarks, not as the actual Florida Medicaid payment amounts. The specific Medicaid rate you receive will be determined based on the AHCA letter addressed to your agency. Furthermore, please note that hospices that fail to submit the required quality-of-care data will receive a reduced payment update; for fiscal year 2027, this results in a net decrease rather than an increase. Therefore, compliance with quality reporting requirements directly impacts revenue.

How to Verify Your Florida Medicaid Hospice Rate

1. Locate the most recent rate letter and spreadsheet from the AHCA (Agency for Health Care Administration) for the current rate year applicable to your agency. The AHCA webpage dedicated to hospice per diem rates publishes the rates by level of care, along with the corresponding rate letters and spreadsheets, every October; therefore, ensure that the version you have covers the dates when the services were provided.
2. Verify each level of care against the information in the rate letter, including the two levels of routine home care, continuous home care, respite care, and general inpatient care.
3. Compare the rate letter with the data actually shown on your payment vouchers (remittance advices). Any discrepancy could indicate an error in the wage index, an outdated rate in your system, or a claim processed under the wrong level of care.
   Separately confirm the room and board rates for patients residing in nursing facilities.
4. Update your hospice administrative management or billing system on October 1st of each year, and perform a test using a sample claim before processing an entire batch.

Document every verification performed. If a payer remits an amount less than what is owed, the rate letter will serve as your primary evidence.

Managed Care: A Second Layer of Rules

Many Medicaid enrollees in Florida receive their benefits through the state’s Statewide Medicaid Managed Care (SMMC) program, and each plan publishes its own provider guidelines regarding the billing of hospice services. While these guidelines generally align with the AHCA’s Hospice Services Coverage Policy, there may be plan-specific differences including procedures for submitting claims for enrollees who are also covered by Medicare, the handling of enrollees receiving long-term care, and specific documentation requirements. Before billing, verify which plan the enrollee belonged to on the date the service was provided, consult that plan’s billing guidelines for hospice services, and take note of any authorization requirements.

Common Florida Medicaid Hospice Billing Mistakes

1. Incorrect calculation of the number of days for routine home care. Applying a reduced rate too early or too late distorts payment.
2. Billing for Intensive Care Services (ICS) outside of the final seven-day period, or exceeding the four-hour daily limit.
3. Billing for room and board without a corresponding stay in a nursing facility, or using an outdated rate.
4. Exceeding bed-hold limits during therapeutic leaves or hospitalizations.
5. Using rates from the previous year following the October 1st update.
6. Billing the incorrect payer for dually eligible patients, without verifying how responsibility is shared between Medicare and Medicaid.
7. Insufficient documentation to support the hours of continuous home care or the necessity for general inpatient care.

A pre-billing review verifying the level of care, dates, units, and the payer for each claim can help detect most of these errors before they result in denials.

Why Hospice Billing Rewards Specialization

Daily rates, tiered pricing, cap calculations, election and certification requirements, and complex payment rules make palliative care one of the most demanding environments for medical billing. Small errors compound over the course of hundreds of days of patient care. Agencies that implement reliable systems for verifying rates, tracking days of care, and reviewing claims protect revenue that would otherwise be quietly lost.

The Takeaway

Florida Medicaid payments for hospice services are predictable only if their structure is well understood. It is essential to be familiar with the revenue codes recognized by the AHCA (Florida Agency for Health Care Administration), apply the correct level of care for each day, account for the Service Intensity Add-on (SIA) as a time-limited supplement, rigorously track room and board expenses as well as bed holds, and always rely on your specific AHCA rate sheet rather than generic figures found online. Furthermore, you should re-verify all information every October when new rates take effect and keep quality reports up to date to avoid reductions in your payment adjustments.

ESOFTX, Inc., a medical billing company based in Levittown, New York, helps healthcare providers improve billing accuracy, track outstanding claims, and reduce avoidable denials. If your hospice agency would like a review of its Florida Medicaid billing workflow, our team is ready to assist you.