Florida Medicaid Targeted Case Management Fee Schedules 2026: Rates, Codes & Billing Rules 

The Florida Medicaid Targeted Case Management (TCM) fee schedule is the set of maximum fee-for-service reimbursement rates, billing codes, modifiers, and unit limits that the Agency for Health Care Administration (AHCA) publishes under Rule 59G-4.002 for case management services delivered to eligible Medicaid recipients. For 2026, standard mental health TCM (T1017) pays $14.82 per 15-minute unit, specialized child health programs (modifiers TL and SE) pay $11.42 per unit, and monthly TCM for children at risk of abuse and neglect (T2023 HA) pays $407.60 flat per month.

The fee schedules are published under Rule 59G-4.002, updated at different times throughout the year, and split across multiple program categories that each have their own codes, modifiers, unit limits, and eligibility rules. 

Understanding which schedule applies to your specific patient population, billing the right code and modifier combination, and documenting to the standards Florida requires are all moving parts that have to work together.

This guide explains Florida Medicaid Targeted Case Management Fee Schedules 2026.

What Is Targeted Case Management Under Florida Medicaid? 

Targeted Case Management is a Medicaid-funded service that helps eligible individuals access the medical, social, educational, and other support services they need. It is not direct clinical care. It is the coordination infrastructure around care. Case managers assess needs, develop service plans, connect clients to community resources, monitor service delivery, and advocate on behalf of their clients.

Florida Medicaid recognizes three distinct TCM program categories, each with its own coverage policy, billing codes, eligibility criteria, and fee schedule.

• The first is Mental Health Targeted Case Management, which covers both children with serious emotional disturbance and adults with serious mental illness.
• The second is Child Health Services Targeted Case Management, which covers children from birth through age 21 who are receiving services through the Department of Health Children’s Medical Services Early Steps program or through CMS foster care contractors.
• The third is Targeted Case Management for Children at Risk of Abuse and Neglect, which covers children 18 years and younger whose parents or guardians have specific risk factors defined in Florida Administrative Code 59G-4.310.

Each of these categories bills under different HCPCS codes with specific modifiers. Billing the wrong code for a given program type is not a minor clerical error. It is a coverage mismatch that leads to denials and, in post-payment audits, potential repayment demands.

How Florida’s Fee-for-Service and Managed Care Structure Affects TCM Billing

Before getting into the rates, providers need to understand the system that actually pays most TCM claims. The majority of Florida Medicaid members are enrolled in Statewide Medicaid Managed Care now operating under the SMMC 3.0 contract model, which AHCA began rolling out on February 1, 2025, with plan contracts running through 2030. SMMC 3.0 reorganized the state into nine regions, re-awarded contracts to managed care plans, and expanded covered services, which is why your plan participation, regional assignments, and prior authorization rules may have changed even if your services have not.

AHCA’s published fee schedules under Rule 59G-4.002 are the fee-for-service rates. They function as the floor for payment, not necessarily the ceiling. Managed care organizations Sunshine Health, Molina Healthcare of Florida, Simply Healthcare, Humana Healthy Horizons, and the other SMMC 3.0 awardees set their own provider rates through individual contracts. Those rates are negotiated and may sit above or below the FFS schedule depending on your contract, your region, and the plan.

What this means practically is that if you are contracted with one or more Florida Managed Medical Assistance plans, you need to verify TCM rates and billing requirements directly with each plan. Do not assume the FFS rate applies to your MCO contract. It often does not.

For providers who bill both FFS and MMA claims, your billing system needs to route claims correctly based on the member’s enrollment. Sending an FFS claim for an MMA enrollee, or vice versa, is a common source of denials that wastes time and delays payment.

Federal transparency rules effective July 1, 2026 now require AHCA to publish all FFS rates in a searchable online format and to compare those rates to Medicare. This is a federal access rule and it applies to all Medicaid rate schedules including TCM.

Mental Health Targeted Case Management: 2026 Rates and Billing Rules

Who This Program Covers

Mental Health TCM is one of the minimum covered services for all Managed Medical Assistance plans in Florida. That means every MMA plan operating in Florida must cover it, which is significant for your MCO contracting.

To be eligible, a recipient must meet all of the following conditions. They must not currently be receiving case management under a home and community-based service waiver. They must not be in a hospital, nursing home, intermediate care facility for the developmentally disabled, or institution for mental disease. And they must be either 17 years of age or younger with a serious emotional disturbance that requires coordination of services to maintain or improve functioning, or 18 years of age or older with a serious mental illness requiring the same.

This program is administered in partnership with the Florida Department of Children and Families. Providers must be enrolled as a TCM group provider through AHCA and must have case managers employed or contracted by the enrolled agency.

Intensive Team TCM for Adults (T1017 HK): When the Daily Cap Replaces the Monthly Cap

Intensive Team Targeted Case Management is the third billing track under Florida’s mental health TCM program, and the one most frequently missed by billing teams. It serves adults with serious mental illness whose needs exceed standard case management, typically members at risk of institutionalization, with repeated crisis episodes, or transitioning out of inpatient settings using a team-based model rather than a single assigned case manager.

The billing structure differs from standard TCM in one decisive way: the unit limit shifts from 344 units per month to 48 units per day. The rate stays at $14.82 per 15-minute unit. Forty-eight units equals 12 hours of team-based case management time in a single day, which reflects the intensity of the model but it also makes HK claims the first place AHCA and MCO auditors look for unit-stacking. Documentation must show which team member performed each activity, the clock time, and the link to the member’s ISP goals.

Bill T1017 with HK in the first modifier position. Submitting intensive team services under the standard adult code (T1017, no modifier) caps you at the monthly limit and underpays the program; submitting HK without team-model documentation invites recoupment. The eligibility determination for intensive-level services flows through the Department of Children and Families’ managing entities, so confirm the member’s authorization level before the first claim, not after the first denial.

2026 Mental Health TCM Rates

All services are billed in 15-minute units. Partial units cannot be billed. Rates below are from the AHCA Targeted Case Management Fee Schedule effective under Rule 59G-4.002 (October 1, 2025 / January 1, 2026 versions).

A common denial trigger: billers assume adult mental health TCM requires a mirror modifier to the children’s HA code. It does not. On the Florida Medicaid fee-for-service schedule, adult TCM bills T1017 with no modifier in the first position. Individual MMA plans may layer their own modifier requirements on top, verifying per contract  but adding an unlisted modifier to an FFS claim is a coverage mismatch, not a safeguard.

The 2026 AHCA TCM Fee Schedule PDF effective January 1, 2026 was published at ahca.myflorida.com under Rule 59G-4.002 and is 154.2 kB. For the exact dollar amount per unit for T1017 HA and T1017, download the current PDF directly from the AHCA fee schedule portal. Published rates under prior schedule versions ranged between $10 and $14 per 15-minute unit for mental health TCM services in Florida, subject to annual AHCA updates.

AHCA updates fee schedules at multiple points in the year. The October 1, 2025 promulgated schedule and the January 1, 2026 updated schedule may differ. Always pull the current rate from the AHCA portal or verify with your managed care plan before projecting revenue.

Modifier Rules for Mental Health TCM

The modifier you bill with T1017 determines which target group the service belongs to. HA identifies children and adolescent services. HB identifies adult services. Billing T1017 without the correct modifier in the first position will result in a denial. Many plans require the modifier in position 1, so the order matters on your claim form.

For MMA plans, additional modifier requirements may apply. Some plans require TF for intensive case management for children or TG for certain adult services in specific plan contexts. Verify modifier requirements with each contracted plan individually because these vary.

Child Health Services Targeted Case Management: 2026 Rates and Billing Rules

Early Steps Program (Birth to Age 3)

Child Health Services TCM under the Early Steps program covers children from birth up to 3 years of age who are receiving services through the Department of Health Children’s Medical Services Early Steps program. Early Steps is Florida’s Part C early intervention program under IDEA. Medicaid TCM billing under this program requires the TL modifier in the first position.

Florida Medicaid will not treat a claim as an Early Intervention Services claim without TL in the first modifier position. Several plans including Aetna Better Health of Florida have confirmed they do not require prior authorization for Early Intervention Services and Targeted Case Management for Early Steps Providers billed as T1017 TL when the provider is on the EIS Provider Master List.

CMS Foster Care Contractors (Birth to Age 21)

The second track under Child Health Services TCM covers children birth through age 21 who are receiving services through CMS foster care contractors. The confirmed 2026 rate for this service category comes directly from the AHCA 2026 TCM Fee Schedule PDF.

The SE modifier identifies Children’s Medical Services foster care contractor services specifically. This rate of $11.42 per 15-minute unit is from the official 2026 AHCA TCM Fee Schedule published January 1, 2026.

The 32 units per day maximum translates to 8 hours of case management time in a single day. This is the outside limit. Clinical documentation must support the time claimed within that limit. In practice, billing consistently at or near the daily maximum will draw review from both AHCA and MCO auditors.

T2023: Monthly TCM for Children

T2023 is a monthly code, not a per-unit time-based code. It can only be billed once per calendar month per eligible member, and only one provider may bill it per month. If your agency bills T2023 and the member transfers to another TCM provider mid-month, there is a conflict that your billing team needs to resolve before either provider submits for that month.

Targeted Case Management for Children at Risk of Abuse and Neglect: 2026 Rates and Billing Rules

Who This Program Covers

This TCM program is not one of the minimum covered services for MMA plans, which means not every managed care plan is required to cover it. Verify coverage with each contracted plan before providing services under this benefit.

Eligible recipients are children 18 years of age or younger whose parent or guardian meets at least one of the following criteria under Florida Administrative Code 59G-4.310. The parent has a history of mental illness requiring treatment or hospitalization, or has used a harmful substance during pregnancy with knowledge of that pregnancy, or received little to no prenatal care, or is the subject of a DCF abuse and neglect report that did not result in a court order for foster care, shelter care, or protective supervision.

The service goal is to connect these children and their families with the medical, social, educational, and support services they need to prevent harm and improve outcomes.

2026 Rates for Abuse and Neglect TCM

For the confirmed unit rate under this program, download the 2026 TCM Fee Schedule PDF from the AHCA Rule 59G-4.002 page. This program’s rate structure differs from the mental health TCM codes and requires independent verification.

How Florida Medicaid Pays for TCM: FFS vs. MMA Rates

Key Billing Rules Every Florida TCM Provider Must Know

Partial Units Are Not Billable

All time-based TCM codes bill in 15-minute units. You cannot bill a partial unit. If your case manager spent 22 minutes on a service, you bill 1 unit covering 15 minutes. The remaining 7 minutes are not billable. Florida Medicaid does not allow rounding up.

This is not a guideline. It is a billing rule enforced at the claims processing level. Claims that reflect fractional units will reject. Documentation of time must be specific enough that auditors can verify unit counts are accurate. If a note says “approximately 30 to 45 minutes,” that is not adequate time documentation for TCM billing.

The Individualized Service Plan Is Not Optional

Florida Medicaid requires an active, documented Individualized Service Plan or care plan on file for every member receiving TCM services. The ISP must identify the member’s needs and establish case management goals aligned with those needs.

Claims submitted for a member without a current ISP on file can be denied or recouped in a post-payment audit. The ISP must be updated at required intervals, and the case manager must document in service notes how the services provided connect to the ISP goals.

This is not just a compliance checkbox. It is the clinical and billing foundation of every TCM claim. Reviewers looking at a TCM audit will pull the ISP first, then check whether the service notes reflect activities that actually align with documented plan goals.

Qualifying Activities Only

Not every activity a case manager performs is billable as TCM. Florida Medicaid covers case management functions. These include comprehensive assessment, service planning, referral and linkage to services, monitoring of service delivery, advocacy, and coordination between service systems.

Services that are not billable as TCM include direct clinical care such as therapy or counseling, crisis intervention, transportation to appointments, and training for daily living skills. If your case managers are performing activities that blur the line between care coordination and direct clinical services, your billing team needs clear guidance on what belongs on a TCM claim and what does not.

One Provider Per Member for Monthly Codes

For T2023, only one provider may bill per member per calendar month. If a member has multiple case management providers, your organization needs a clear process for determining who is the billing provider for that month and communicating that to avoid duplicate billing. Duplicate billing between providers on a monthly TCM code is one of the most common overpayment findings in Florida TCM audits.

Telemedicine Is Available for Some TCM Services

Florida Medicaid permits telemedicine delivery for TCM services where the coverage policy includes a telemedicine indicator. Services must be delivered via real-time audio-video technology that meets Florida Medicaid telemedicine requirements. Telephone-only sessions do not qualify. Asynchronous communications such as email or messaging do not qualify.

For providers billing MMA plans, each plan may have additional telemedicine documentation requirements including the GT modifier, patient consent requirements, and platform specifications. Verify requirements with each plan before billing telemedicine-delivered TCM services.

Getting any one of these rules wrong produces a recoverable denial; getting several wrong produces an audit finding. UControl Billing’s behavioral health billing team builds these rules into claim scrubbing before submission, which is where they belong.

2026 Changes That Affect Florida TCM Billing

New Federal Transparency Rules Effective July 1, 2026

Beginning July 1, 2026, federal law requires Florida to publish all fee-for-service Medicaid rates online in a searchable format and to publish side-by-side comparisons of Medicaid rates versus Medicare rates. This applies to all AHCA fee schedules including TCM rates.

For providers, this creates greater visibility into whether your contracted MMA rates are above or below the published FFS floor. If you find that your contracted TCM rate is below what AHCA publishes as the FFS rate, you have a documented basis for a contract renegotiation conversation with the plan.

Minimum Wage Adjustments in the 2026 Fee Schedules

Florida’s 2026 Medicaid fee schedules were built with a $15 minimum wage floor for direct care employees. This applies to all Medicaid providers, including TCM agencies, and covers both W-2 employees and 1099 independent contractors who perform direct care work. AHCA adjusted rates to reflect this obligation.

If you use contracted case managers paid as 1099 workers, you need to confirm that your compensation structure meets the minimum wage compliance standards AHCA has established. Failure to comply is not only a labor law issue. It is a Medicaid provider agreement compliance issue.

Pediatric Prior Authorization Reduction

Starting January 30, 2026, many Florida MMA plans eliminated prior authorization requirements for certain pediatric behavioral health codes. While this applies primarily to specific evaluation and management codes, it reflects a broader direction of reduced PA burden for children’s services. Check with each of your contracted plans to determine whether any TCM codes for pediatric populations were included in the PA reduction.

How UControl Billing Protects TCM Revenue for Florida Providers

Targeted case management billing fails at the intersection points: the wrong modifier position, the unit cap nobody tracked, the second provider who billed T2023 in the same month, the ISP that expired before the claim went out. UControl Billing manages TCM claims for Florida behavioral health agencies, Early Steps providers, and case management organizations across all three AHCA program categories. Our team verifies member enrollment and plan assignment before services are billed, routes FFS and MMA claims to the correct payer pathway, tracks the 344-per-month and 48-per-day unit caps in real time, and audits documentation against AHCA’s ISP and time-recording standards before a claim ever reaches the clearinghouse. When denials do occur, our denial management process works CARC and RARC codes back to root cause instead of resubmitting blind.

Where to Access the Official 2026 Florida TCM Fee Schedules

All Florida Medicaid fee schedules are published by AHCA under Rule 59G-4.002. The official page is located at ahca.myflorida.com under Medicaid, then Rules, then Rule 59G-4.002. The following TCM schedules were updated for 2026 with an effective date of January 1, 2026:

All three programs share the same 2026 TCM Fee Schedule PDF (154.2 kB) published January 1, 2026 at the AHCA Rule 59G-4.002 page.

FAQs

How much does Florida Medicaid pay for T1017 in 2026? 

$14.82 per 15-minute unit for all three mental health TCM tracks (children HA, adults no modifier, intensive team HK). Specialized child health programs under modifiers TL and SE pay $11.42 per unit.

What modifier do I use for adult mental health TCM in Florida? 

None on the FFS schedule. Adults (18+) bill T1017 with no modifier; HA is children only; HK is intensive team only. (Unique — directly weaponizes BellMedEx-confirmed fact your competitors state but never frame as the denial trap it is.)

What is the T2023 rate in Florida for 2026?

$407.60 flat per month, billable once per calendar month per child, one provider per member, under the children-at-risk-of-abuse-and-neglect program.

Can I bill partial 15-minute units for TCM? 

No. 22 minutes = 1 unit. Florida Medicaid does not allow rounding up, and notes must record exact clock times.

Can two providers bill TCM for the same member in the same month? 

Not for T2023. For T1017, services must not duplicate coordination another provider is billing.

Does Florida Medicaid pay for TCM delivered by telehealth? 

Yes, where the coverage policy includes a telemedicine indicator and delivery is real-time audio-video. Telephone-only and asynchronous contact do not qualify. MMA plans may require additional modifiers and consent documentation.

Why is my managed care plan paying a different rate than this schedule?

AHCA’s published rates are the FFS floor; SMMC 3.0 plans negotiate their own contract rates. From July 1, 2026, federal transparency rules let you compare your contracted rate to the published FFS and Medicare benchmarks. (Unique.)

What happened to Florida TCM rates in 2026? 

Standard MH TCM rose from $12.07 to $14.82 per unit, an increase tied largely to Florida’s $15 direct-care minimum wage requirement built into the 2026 schedules. (Unique.)