First Coast Medicare: Florida’s Medicare contractor, fee lookups and localities

First Coast Medicare is the common search phrase for First Coast Service Options and its Medicare provider resources. CMS identifies First Coast as the A/B Medicare Administrative Contractor for Jurisdiction N, which includes Florida, Puerto Rico and the U.S. Virgin Islands.

For a practice billing chronic care management, start by identifying the question: service requirements, a locality-specific fee, or a particular claim. Those questions lead to different resources. This guide helps a Florida billing lead find the right starting point without confusing a contractor’s jurisdiction with a payment locality.

What First Coast Medicare does for practices

CMS describes MACs as the operational contact between Medicare fee-for-service and enrolled providers. Their activities include processing claims, making payments, enrolling providers, responding to provider inquiries and educating providers about billing requirements. They also handle redetermination requests and review selected medical records.

First Coast is the A/B contractor for its defined jurisdiction. That role does not make First Coast a chronic care management company or a separate clinical program. A practice still needs to understand the service it furnishes and the documentation supporting its claim.

Question	Starting resource	Prepare before opening it
Where is the official provider site?	First Coast provider home page	Part A or Part B area of interest
What is a code’s local fee?	First Coast fee-schedule lookup	Code, service date and locality
What are the CCM service requirements?	CMS CCM booklet and FAQs	Program, code family and service month
Where is billing guidance for a specialty?	First Coast Specialties/Services	Specialty and procedure code
What does a claim response mean?	First Coast claims resources and official contact channels	Claim response and the specific unresolved question

Begin at the official First Coast Medicare provider website. Its navigation includes Fee Schedule Lookup, SPOT, Claims Resources, Enrollment, Specialties/Services and Contact Us. Use the official site when a search result points to an older contractor page or an unofficial summary.

How to use the Medicare First Coast fee schedule

First Coast’s published search instructions tell providers to enter the applicable CPT or HCPCS code, date of service and locality. Check the status indicator as well as the amount. A result for the wrong year or locality does not answer the practice’s payment question.

1. Identify the code and date of service you need to research.
2. Confirm the relevant service-location payment locality.
3. Open the official fee-schedule lookup from First Coast’s website.
4. Enter the code, service date and locality in the search.
5. Read the amount and status indicator together.
6. Keep the lookup basis with the practice’s billing review.

CMS’s payment-locality rule follows where the practitioner furnished the service, using the relevant practice-address and ZIP information on the claim. Do not simply select the patient’s home ZIP or assume all Florida locations share one amount. The jurisdiction tells you the contractor; the locality supplies a different part of the payment calculation.

The chronic care management reimbursement guide explains the rate basis and provides qualified locality illustrations. Use its state summaries for comparison, then verify the practice’s actual locality. Keep the code, year, setting and practitioner basis together when comparing two numbers.

A fee-schedule amount also does not establish that the month’s service is billable. The patient, consent, care plan and actual qualifying work must support the code. Treat the rate lookup as one part of review rather than permission to submit a monthly claim.

How CCM billing works month to month

1. Confirm the patient and prerequisites

CCM concerns two or more chronic conditions expected to last at least 12 months or until death that place the patient at significant risk. The practice assesses duration and risk alongside the diagnoses. Two diagnosis codes alone are not the complete eligibility assessment.

New patients and patients not seen by the billing practitioner within the previous year need an initiating visit before CCM starts. The visit can be a qualifying comprehensive face-to-face E/M visit, annual wellness visit or IPPE. CCM must be discussed for the visit to serve as initiation.

2. Document consent before billing

Obtain written or verbal informed consent and record it in the medical record. Explain availability, possible cost sharing, that only one practitioner can furnish and bill CCM per calendar month, and the right to stop effective at month end. Record whether the patient accepts or declines.

The initiating visit and informed consent are separate requirements. Consent need not occur during that visit, but it must precede billing. Without required consent, neither Medicare nor the patient may be billed for CCM.

3. Maintain the plan and monthly service record

CMS calls for an electronic comprehensive care plan based on the patient’s assessed needs and available supports. The team provides relevant coordination, communication and medication-management work around that plan. Record what occurred and connect unresolved clinical questions with the responsible practitioner.

For clinical-staff CCM, 99490 requires at least 20 qualifying minutes per calendar month; 99439 describes each additional 20 minutes. Qualifying personnel and actual activities matter alongside the time total. A record of enrollment or an attempted contact does not by itself demonstrate the required service.

4. Review the claim and any contractor response

The billing practice checks the prerequisites, service and code selection before submission. The CCM billing guide develops that process in greater detail. Keep the clinical record and the fee-schedule lookup available to the person reviewing a later claim question.

If a response is unclear, identify whether the issue concerns the submitted information, payment basis or service documentation. Use the relevant official First Coast resource or contact channel with that focused question. Do not assume that resubmitting the same information will resolve an unexplained issue.

National rules and local administration answer different questions

CMS’s CCM booklet and FAQs describe the service elements and billing prerequisites. First Coast’s resources help providers navigate its contractor tools and applicable guidance. Reading both prevents the fee-schedule result from becoming a substitute for the service rules.

First Coast specifically warns that a procedure can have policies or guidelines besides an LCD. Its instructions recommend a standard site search, a fee-schedule search, the Provider Specialties center and the NCCI procedure-to-procedure lookup as relevant research paths. An unsuccessful LCD search is therefore not the end of a code review.

Read the cited policy itself and check the service and dates it addresses. A search snippet can omit conditions or describe a different procedure. Preserve the source URL and the precise question it resolves so another staff member can understand the decision.

• Use national CMS material for the defined CCM service requirements.
• Use the contractor lookup for the selected code, date and locality.
• Use the specialty resources for procedure-specific billing information.
• Use official claim channels for questions about a particular response.

Common First Coast Medicare misunderstandings

A practice working with an external CCM team still retains required practitioner involvement and oversight. CMS allows contracted clinical staff arrangements when incident-to and other requirements are met. Little oversight or a lack of clinical integration can prevent the service from qualifying.

A contractor question should identify the actual service and responsible billing practitioner. An external arrangement does not change who bills under the practice’s license. Keep the agreement’s role assignments available alongside the operational record.

For patient benefit questions, First Coast’s provider tools serve a different audience from general Medicare information. The provider home page is organized around claims, enrollment, fee schedules and billing resources. Start with the resource intended for the person and question involved.

Review the support around your monthly CCM record

Explore chronic care management services for practices when reviewing enrollment, outreach and documentation responsibilities. Bring the tasks your practice needs to coordinate with its own billing review.

Your team refers; we handle enrollment, outreach and documentation. You bill monthly under your license. Which team members’ time counts toward each code is set in your services agreement.

Key takeaways

• First Coast is the Jurisdiction N A/B Medicare contractor.
• Choose the official resource that matches the billing question.
• Search fees using the code, service date and actual locality.
• Document the CCM prerequisites and actual monthly service.
• Keep the practice’s billing responsibility clear in external arrangements.

Frequently asked questions about first coast medicare

Is First Coast Medicare the same as First Coast Service Options?

First Coast Medicare is a common search phrase for First Coast Service Options’ Medicare resources. CMS names First Coast Service Options as the A/B contractor for Jurisdiction N.

Does First Coast handle Medicare claims nationwide?

Its A/B jurisdiction covers Florida, Puerto Rico and the U.S. Virgin Islands. Verify the appropriate MAC for a practice outside that jurisdiction.

What should I enter in the First Coast fee-schedule search?

First Coast instructs providers to enter the procedure code, date of service and locality. Review the code’s status indicator with the result.

Does a First Coast fee result mean CCM can be billed?

No, the fee search does not establish the patient’s prerequisites or the month’s qualifying service. Review the CCM requirements and supporting record separately.

Is an LCD the only place to research a First Coast billing question?

No, First Coast says a procedure can have policies or guidelines besides an LCD. Its site search, fee lookup and specialty resources can lead to other relevant information.

Can an external CCM arrangement transfer the billing practitioner’s involvement?

CMS requires the billing practitioner to retain a level of involvement. The practice needs oversight and clinical integration with any external team.

Physician practices billing Medicare Part B chronic care management, including 99490 and 99439, distinguish national service rules from contractor administration. For Companian, your team refers; we handle enrollment, outreach and documentation. You bill monthly under your license.

Read more: CCM reimbursement · CCM billing · CCM CPT codes

Rates & disclosures

National amounts are 2026 Medicare Physician Fee Schedule non-facility payments at the non-QP conversion factor of $33.4009, computed from CMS RVUs. Your amount depends on your Medicare payment locality; see it in the CCM/PCM revenue calculator. Actual payment depends on participation status, place of service and cost-sharing.

Companian supplies Care Advocates and documentation to physician practices nationwide. Companian is not a medical practice and does not bill Medicare. The billing practitioner keeps the care plan, every clinical decision and the claim. Patients pay the usual Medicare Part B deductible and coinsurance for these services unless other coverage pays it.

This guide summarizes CMS information for physician practices. It is not legal or billing advice.