Florida PPEC Fee Schedule: Current Procedure Code Rates

Current fee schedule amounts — effective July 1, 2025 (AHCA)

$281.68

T1025 per-diem rate per day of PPEC day program service. Covers the full day program attendance unit.

$44.73

T1026 hourly rate per hour of PPEC skilled nursing or therapy service billed separately from the day program.

59G-4.200

Florida Medicaid PPEC coverage policy rule governing service requirements, authorization, and documentation standards.

Rate verification note: Rates shown reflect AHCA fee schedule amounts effective July 1, 2025, sourced from AHCA fee schedule documentation. Florida Medicaid fee schedules are updated periodically. Operators should verify current rates directly with AHCA before relying on these amounts for billing or financial planning. AHCA publishes current fee schedules at ahca.myflorida.com.

Florida PPEC reimbursement through the Medicaid fee-for-service program is denominated in two procedure codes. T1025 is billed as a per-diem rate covering a full day of PPEC day program services. T1026 is billed as an hourly rate for skilled nursing or therapy services that are provided as components separate from the day program unit. Understanding which code applies, when both can be billed, and what documentation each requires is foundational to billing accuracy for PPEC operators.

The procedure codesT1025 and T1026: what each covers

Florida Medicaid reimburses PPEC services under two procedure codes defined in the PPEC coverage policy at Florida Administrative Code Rule 59G-4.200:

T1025 — Attendant care services, per diem. T1025 is the primary per-diem code for PPEC day program attendance. It covers a full day of PPEC services when the enrolled child attends the center for the authorized day program. The current fee schedule rate is $281.68 per day (effective July 1, 2025).

T1026 — Attendant care services, per hour. T1026 is the hourly code for PPEC services billed at an hourly rather than per-diem rate. It is used for skilled nursing or therapy services provided outside the standard day program unit, or when hourly service authorization is in effect. The current fee schedule rate is $44.73 per hour (effective July 1, 2025).

Billing rulesAuthorization, units, and documentation

Reimbursement under T1025 and T1026 is contingent on prior authorization and accurate documentation. AHCA’s PPEC coverage policy at Rule 59G-4.200 specifies the documentation and authorization requirements that govern billing under each code. Key operational points:

• Prior authorization is required for PPEC services under both T1025 and T1026. The authorization establishes the approved service type, authorized units, and coverage period. Billing without a valid, current authorization results in denial.
• T1025 and T1026 may both apply to the same client depending on the client’s authorized service plan. A client authorized for day program attendance (T1025) may also have a separate T1026 authorization for skilled nursing hours that are documented and billed independently.
• Daily attendance documentation is required to support T1025 claims. AHCA and, for managed-care-enrolled clients, the MCO, will require documentation that the client attended on each billed date.
• Nursing and therapy notes are required to support T1026 claims. Each billed hour must be substantiated by documentation describing the service provided, the clinician, and the time.
• For MCO-enrolled clients, authorization and documentation requirements follow the plan’s clinical criteria, which may exceed or differ from AHCA’s FFS requirements. Operators should confirm plan-specific standards directly with each MCO.

FFS vs. MCORate applicability by billing rail

The rates shown in this article — $281.68/day for T1025 and $44.73/hour for T1026 — are Florida Medicaid fee-for-service amounts. They apply to clients whose care is authorized and billed through the FFS rail.

For clients enrolled in a Statewide Medicaid Managed Care plan, reimbursement rates are set by each MCO within the parameters of its contract with AHCA. MCO rates for T1025 and T1026 may be equal to, higher than, or lower than the FFS schedule, depending on the plan and the operator’s contracted rate. Operators should not assume that the FFS amounts above reflect what any specific MCO will pay for the same services.

The majority of Florida PPEC clients are estimated to be enrolled in SMMC plans. For most operators, a significant portion of their billable census is governed by MCO rates, not by the FFS schedule. See also: Florida PPEC: Fee-for-Service and Managed Care Billing in Practice.