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    v1.0.30
    OpenPayerPolicy UpdatesReimbursement/Payment PolicyAHCA FL MPIP Payment Policy Update | OpenPayer
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    CurrentAgency for Health Care AdministrationPolicy 2023-05

    Updated MMA Physician Incentive Program (MPIP) Requirements Year 7

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    Updates Statewide Medicaid Managed Care requirements for Managed Medical Assistance and MMA Specialty plans participating in the MMA Physician Incentive Program, including Medicare-rate reimbursement, pediatric E/M codes, deleted CPT codes, billing-system implementation, and claim reprocessing.

    Policy Summary
    PayerAgency for Health Care Administration
    PolicyUpdated MMA Physician Incentive Program (MPIP) Requirements Year 7
    Policy CodePolicy 2023-05
    Change TypeRevised reimbursement and coding requirements
    Effective DateJanuary 1, 2023
    Next Review DateN/A
    Key ActionManaged care plans must implement MPIP payment rates for eligible physicians at rates equal to or exceeding Medicare rates for covered services.
    SourceLink
    POLICY UPDATE CHANGES

    MMA plans must use the attached Children's Primary Care Codes rates as the Medicare-equivalent rates for MPIP-qualified providers billing specified pediatric E/M codes that are not listed on the Medicare fee schedule.

    CPT codes 99241, 99251, 99339, and 99340 were deleted from the MPIP E/M Procedure Codes Medicare rates file.

    Managed care plans must program their billing systems to implement the updated MPIP payments and reprocess affected claims paid before the pricing updates.

    MMA and MMA SpecialtyApplicable benefits
    Medicare parity

    OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.

    Payment standard
    4 CPT codesDeleted codes
    60 daysBilling-system deadline
    90 daysClaim reprocessing deadline

    MPIP Reimbursement Eligibility

    MPIP Reimbursement and Coding Requirements

    MPIP-qualified providers are eligible for reimbursement when the managed care plan applies the MPIP Medicare-rate and coding requirements below.

    MPIP reimbursement and coding requirements

    • Reimbursement basis

      • For services provided on or after January 1, 2023, payment rates for eligible physicians must equal or exceed Medicare rates, as implemented through the MMA Physician Incentive Program (MPIP).
      • For pediatric Evaluation and Management (E/M) CPT codes included in the MPIP but not listed on the Medicare fee schedule, the managed care plan must use the rates in the Children's Primary Care Codes list as the 2023 Medicare rates.

    • MPIP E/M coding updates

      • The following CPT codes were deleted effective January 1, 2023 and are no longer included in the MPIP E/M Procedure Codes Medicare rates file: 99241, 99251, 99339, and 99340.

        Do not use these deleted codes for MPIP E/M Medicare-rate pricing.

    • System implementation and claim reprocessing

      • The managed care plan must program its billing systems to make the required MPIP payments.No later than August 8, 2023

        This deadline is 60 days from the release of Policy Transmittal 2023-05.

      • The managed care plan must reprocess MPIP-qualified provider claims paid before the billing-system pricing updates.By September 8, 2023

        This deadline is 90 days from the release of Policy Transmittal 2023-05.

    Payment and Procedure Code Requirements

    Deleted MPIP E/M procedure codesCPTNot Covered
    99241Deleted CPT code; no longer included in the MPIP E/M Procedure Codes Medicare rates file.
    99251Deleted CPT code; no longer included in the MPIP E/M Procedure Codes Medicare rates file.
    99339Deleted CPT code; no longer included in the MPIP E/M Procedure Codes Medicare rates file.
    99340Deleted CPT code; no longer included in the MPIP E/M Procedure Codes Medicare rates file.
    Pediatric E/M codes listed in the MPIP attachment but not listed on the Medicare fee scheduleCPTCovered
    No codes listed
    Physician payment floor
    Payment standardPayment rates for eligible physician services must equal or exceed Medicare rates.
    Responsible plansMMA plans must implement the incentive program payment rates.
    Eligible recipientsThe requirement applies to eligible physicians providing covered services.
    Billing-system implementation deadline
    Required actionManaged care plans must program their billing systems to implement the updated MPIP payments.
    DeadlineImplementation must begin no later than 60 days from the release of the policy transmittal.

    Required Managed Care Plan Actions

    Billing Rule

    Apply Medicare-rate payment parity

    Implement MPIP payment rates for eligible physicians at rates equal to or exceeding Medicare rates for covered services.

    Billing Rule

    Implement updated MPIP E/M pricing

    Update billing systems to exclude CPT codes 99241, 99251, 99339, and 99340 from the MPIP E/M Procedure Codes Medicare rates file. Reprocess MPIP-qualified provider claims paid before the pricing updates by September 8, 2023, or within 90 days of the transmittal release.

    • Billing-system updates must be implemented by August 8, 2023, or within 60 days of the transmittal release.
    • Deleted codes: 99241, 99251, 99339, and 99340.

    Program and Provider Terms

    MMA Physician Incentive Program (MPIP)
    Program nameMMA Physician Incentive Program (MPIP).
    Program administratorAn incentive program implemented by the Agency to satisfy the requirement for Medicare-rate-based physician payments.
    Payment functionMMA plans provide required payments to eligible physicians for specified services at rates equal to or exceeding Medicare rates.
    MPIP-qualified provider
    DefinitionA provider eligible for reimbursement under the MMA Physician Incentive Program.
    Program connectionThe provider receives reimbursement through the Agency-implemented MPIP.
    Policy Summary
    PayerAgency for Health Care Administration
    PolicyUpdated MMA Physician Incentive Program (MPIP) Requirements Year 7
    Policy CodePolicy 2023-05
    Change TypeRevised reimbursement and coding requirements
    Effective DateJanuary 1, 2023
    Next Review DateN/A
    Key ActionManaged care plans must implement MPIP payment rates for eligible physicians at rates equal to or exceeding Medicare rates for covered services.
    SourceLink
    On This Page
    MPIP Reimbursement EligibilityPayment and Procedure Code RequirementsRequired Managed Care Plan ActionsProgram and Provider Terms
    Specified dateThe stated implementation deadline is August 8, 2023.
    Claim reprocessing deadline
    Required actionPlans must reprocess MPIP-qualified provider claims paid before the billing-system pricing updates.
    DeadlineAffected claims must be reprocessed within 90 days of the release of the policy transmittal.
    Specified dateThe stated claim-reprocessing deadline is September 8, 2023.
    Payment basis
    Reimbursement is based on the program requirement that eligible physician service rates equal or exceed Medicare rates.