MedicaidReimbursementMedium impact
Coverage of Congenital Cytomegalovirus (CMV) Screening - Key Medicaid Information for Fee-for-Service and Managed Care Providers
Florida Medicaid·FL · Pediatrics·Medical Policy
Effective date
Jul 1, 2024
We identified it
Jun 16, 2026
Summary
Florida Medicaid now provides additional reimbursement of $21.05 for congenital CMV screening (CPT 87496) for qualifying newborns, paid separately from DRG payments. Providers can submit claim adjustments for services back to July 1, 2024.
Action Required
Immediately: Billing team should submit claim adjustments for CMV screening (CPT 87496) with dates of service on or after July 1, 2024, using frequency code '7' and the 13-digit ICN of the original paid claim. For claims exceeding 12-month submission limits, use exceptional claims process via Florida Medicaid Secure Web Portal. Update billing system to capture additional $21.05 reimbursement for qualifying newborn CMV screenings.