Exemption to this limit automatically applies to the following:
- Recipients under the age of 21
- A pregnancy-related diagnosis code associated with the visit
- Visits provided in county health departments, federally qualified health clinics or rural health clinics
- The rendering provider has another specialty on their enrollment file
- End-stage cirrhosis and ascites (requiring adjustments to diuretic medications and check of potassium levels)
- Diabetes with complications of peripheral neuropathy resulting in infected foot ulcer (requires frequent visits for antibiotics, debridement)
- Pneumonia and comorbidities (to monitor treatment response)
- New onset of syncope (evaluation, review of studies and follow-up)
Send your claims with documentation describing the medical necessity of the visit to your local Medicaid area office addressed with “Attention: Exceptional Claim Process.” Contact information for the Medicaid area offices can be found at http://www.mymedicaid-florida.com/.
The Agency wishes to thank you for your continued care of our Medicaid recipients. Your cooperation in this effort is appreciated.