Updates and Resources
Policy and Fee Schedule Frequently Asked Questions (FAQ) November 2022
Behavior analysis (BA) services are highly structured interventions, strategies, and approaches provided to decrease maladaptive behaviors and increase or reinforce appropriate behaviors. More information, including fact sheets and videos, is located on the Behavior Analyst Certification Board’s website.
Up-to-date information regarding Florida Medicaid behavior analysis service can be found here. Providers can also signup receive to provider alerts by registering at
|Behavior Analysis providers must have a National Provider Identified (NPI)||All rendering, ordering, prescribing, or attending providers enrolled in Florida Medicaid must have a National Provider Identifier (NPI) on file with the Agency to comply with federal requirements.
Please see this March 4, 2022 provider alert for specific NPI information for behavior analysis providers. You can also review more recent NPI detailed information in this provider alert archive:
For questions, please contact Provider Enrollment 1-800-289-7799, Option 4
Fee Schedule Transition to Current Procedural Terminology (CPT) Codes
|The Agency adopted the American Medical Association (AMA) Current Procedural Terminology (CPT) codes for the Florida Medicaid Behavior Analysis fee schedule, effective August 1, 2022. The current 2022 fee schedules are available on the Agency’s reimbursement schedule page, Rule 59G-4.002, Provider Reimbursement Schedules and Billing Codes.
If you have questions regarding the behavior analysis prior authorization process, contact eQHealth Solutions via email at firstname.lastname@example.org or call 855-440-3747.
|Behavior Analysis Coverage Policy||The Agency is promulgating an update to the BA Services Coverage Policy.|
The Agency temporary moratorium on enrollment of new BA group providers and individual providers practicing independent of a group in Miami-Dade and Broward counties expired November 13, 2022.
|Multidisciplinary Team (MDT)||
MDT Updates: Provides information to behavior analysis providers in Regions 4 and 7
The Agency directed eQHealth Solutions, Inc. to implement a multidisciplinary team approach to reviewing prior authorization requests for behavior analysis services in Regions 4 and 7, as a pilot, beginning July 1, 2019. As a part of the MDT review process, all requests for more than 20 hours per week must undergo a telephone or face-to-face staffing to ensure the child is receiving all necessary services and supports. While this approach has proven valuable in obtaining additional information about the needs of the child, the Agency has identified opportunities to streamline and expedite the process, while continuing to engage providers and parents.The Agency has limited the circumstances in which an MDT meeting is needed, as follows:
eQHealth will only initiate MDT meetings in cases where convening treatment providers may be of benefit in maximizing the treatment outcomes, particularly where progress has stalled or regressed over several review periods.
It is of chief importance to us to solicit input from parents prior to making a service authorization decision, so eQHealth will continue to contact the child’s parent/guardian prior to completing the review to collect information and to discuss any additional needs that may have arisen.For more information, please visit the eQHealth Training Resources page.
|Topic||Date and Time||Link|
|eQHealth Solutions' Multidisciplinary Trainings||Recurring||Register for these trainings on eQHealth Solutions' website: http://fl.eqhs.org/ProviderResources/Registerforawebinar.aspx|
|July 29, 2022 BA Fee Schedule Training||Webinar Recording|
|Behavior Analysis Provider Enrollment (May 2019)||Presentation: Enrolling as a Florida Medicaid Behavior Analysis Provider
Webinar Recording: Enrolling as a Florida Medicaid Behavior Analysis Provider
|Behavior Analysis Provider Enrollment (April 2019)||Medicaid Behavior Analysis (Provider Type 39) Enrollment Webinar|
1. What are Behavior Analysis (BA) Services?
Behavior analysis services provide a way for a person to reduce unwanted behaviors and increase desired behaviors.
2. Who can receive BA Services?
Florida Medicaid covers BA services for eligible Florida Medicaid recipients under the age of 21 years requiring medically necessary BA services. BA services for eligible individuals 21 years and older are available through the iBudget Waiver.
3. Who is eQHealth?
eQHealth Solutions is the company that reviews all requests for BA services covered under Florida Medicaid. A BA provider will submit the service request to eQHealth, which will review the service need based on medical necessity. After the determination is made, eQHealth will send you a letter.
4. How do I find a provider?
A link to BA service providers can be found on the Agency’s Recipient Support webpage under Additional Reference Information.
5. What are the steps I take to get BA services?
6. Who can I contact if I have more questions?
Please call the Medicaid helpline at 1-877-254-1055, if you have more questions.
7. Who can I contact if I am having issues with receiving BA services?
Please contact the Medicaid helpline at 1-877-254-1055 to report those issues.
8. What is a prior authorization number?
A prior authorization number is a number that is 10 digits long, has no hyphens, and begins with “5.”
To obtain approval for Behavior Analysis services, providers must submit all new authorization requests to eQHealth Solutions, the Agency’s contracted Quality Improvement Organization for this service. For further information, please reference the following:
Authorizations without a CDE are temporary. These alternative assessments do not replace the requirements for a CDE. If parents are having difficulty finding a provider to perform the CDE, their child’s health plan is available to help. Parents can also contact the Agency at 877-254-1055 and we will work with them or their child’s plan to find a provider.
To learn more about the provider enrollment process for behavior analysis services, please review the presentation materials on the Agency’s website. For additional assistance, please contact a customer service representative at 1-800-289-7799, Option 4.Additional information is available on the Agency’s website: