Florida Medical Lien Law for Outpatient Providers (2026)

Florida has no statewide medical lien law for outpatient practices. Physicians, chiropractors and therapists who treat injury patients on credit rely on letters of protection and, in auto cases, on PIP. Since March 2023, a Florida statute controls what must be disclosed about a letter of protection and how medical bills are valued in the injury case.

At a glance

Question	Answer
Statutory lien for outpatient providers	None found. Hospital liens exist only where a county ordinance creates one.
Main law	No lien statute. Related laws: Fla. Stat. § 768.0427 (letters of protection and medical damages), § 627.736 (PIP), § 768.76 (collateral source setoff)
What outpatient providers usually rely on	Letters of protection and lien agreements, plus PIP billing in auto cases
Notice or filing	No lien filing for outpatient providers. If care is under a letter of protection, the patient must disclose the letter, itemized coded bills, any sale of the bill, insurance status and the referral source (§ 768.0427(3)).
Limits on the amount	No lien cap. Under PIP, the insurer may pay 80% of a fee schedule that is generally 200% of Medicare Part B, and the provider may not bill the insured for the difference.
Health insurance and billing the patient	PIP is primary in auto cases. Balance billing is restricted for PIP and for HMO-covered services. For an insured patient treated under a letter of protection, damages are valued at what the insurance would have paid.
Billed vs. paid in the case	Paid bills count at the amount actually paid. Unpaid bills are valued by insurance rates, or 120% of Medicare (170% of Medicaid) for uninsured, Medicare or Medicaid patients. A factoring price is admissible.
Recent changes (2023–2026)	HB 837 (2023) created § 768.0427, cut the negligence filing deadline from 4 years to 2, and bars recovery for a plaintiff more than 50% at fault.

Is there a lien law for outpatient providers?

We could not confirm any Florida statute, in a primary source, that gives physicians, chiropractors, physical therapists or other outpatient providers a lien on a personal injury recovery.

Hospital liens in Florida are local. In Shands Teaching Hospital & Clinics, Inc. v. Mercury Insurance Co. of Florida (Fla. 2012), the Florida Supreme Court struck down an Alachua County special act that created a hospital lien. The Florida Constitution bars special laws creating liens based on private contracts. The Court upheld the county's hospital lien ordinance, and said the Legislature has no pervasive regulatory scheme for hospital liens that would preempt it.

Notice and filing

Because there is no statutory lien for outpatient providers, there is no statewide filing step. The disclosure duty that does exist falls on the patient. Under Fla. Stat. § 768.0427(3), a patient seeking medical damages for treatment under a letter of protection must disclose, before the claim can go forward:

a copy of the letter of protection;
all bills, itemized and, where applicable, coded;
if the provider sold the bill to a factoring company or other buyer, the buyer's name and the price paid;
whether the patient had health coverage at the time of treatment, and what type;
whether the patient was referred for treatment under a letter of protection, and if so, by whom.

Limits on what the provider is paid

No statute caps what an outpatient provider can collect under a letter of protection. What the provider is paid depends on the agreement and on what the patient can prove as damages.

In auto cases, PIP sets its own limits under Fla. Stat. § 627.736:

PIP pays 80% of reasonable, medically necessary medical expenses, within a $10,000 limit.
Initial care must be received within 14 days of the accident.
Benefits are capped at $2,500 unless a listed provider finds an emergency medical condition.
Massage and acupuncture are excluded.
Providers may charge only a reasonable amount. The insurer may limit payment to 80% of a fee schedule that, for most services, is 200% of the Medicare Part B allowable.
Bills may not include charges for services more than 35 days before the postmark date. This extends to 75 days if a notice of initiation of treatment is sent within 21 days.
Amounts paid or payable by PIP cannot be recovered as damages in the injury case.

Lien agreements and letters of protection

Florida law expressly recognizes letters of protection. Section 768.0427(1) defines one as any arrangement where a provider treats in exchange for a promise of payment from a judgment or settlement, whatever it is called.

For cases filed after March 24, 2023, the statute also says:

If the patient's attorney referred the patient to the provider, that fact may be disclosed and is admissible, notwithstanding the attorney-client privilege.
A law firm's financial relationship with a provider, including the number and frequency of referrals and the financial benefit, is relevant to the bias of a testifying medical provider.
If the provider sells the bill, the amount the factoring company paid is admissible evidence of the medical expense.

The attorney's duty to pay the provider

Rule 5-1.1 of the Rules Regulating The Florida Bar sets the patient's attorney's trust account duties:

A lawyer who receives funds in which a third person has an interest must promptly notify that person and promptly deliver what they are entitled to receive (Rule 5-1.1(e)).
Funds claimed by two or more persons must be held in trust, with any disputed portion kept separate until the dispute is resolved (Rule 5-1.1(f)).
The comment says a lawyer may have a duty under applicable law to protect a third party's claim. When that duty exists and the claim is not frivolous, the lawyer must refuse to release the funds to the client until the claims are resolved. The lawyer should not decide the dispute alone and may consider depositing the funds with the court.

Whether a given letter of protection creates that duty depends on its terms and on applicable law.

Health insurance, no-fault and billing the patient

PIP comes first in auto cases. PIP benefits are primary (§ 627.736(4)).
No balance billing above PIP limits. If the insurer limits payment under the fee schedule, the provider may not bill or try to collect the excess from the insured, except coinsurance or amounts over policy limits (§ 627.736(5)(a)4).
HMO patients. A provider may not collect from an HMO member for services the HMO is liable for, whether or not the provider has a contract with the HMO (Fla. Stat. § 641.3154).
Insured patients treated under a letter of protection. If the patient has commercial coverage but treats under a letter of protection, or the charges are not submitted, the evidence of damages is what that coverage would have paid plus the patient's share (§ 768.0427(2)(b)2).

We could not confirm a rule in a primary source on whether a provider can collect the unpaid balance from the patient after a lost or small case.

Billed vs. paid medical damages

For cases filed after March 24, 2023, § 768.0427(2) controls the evidence of medical damages:

Paid bills: limited to the amount actually paid, from any source.
Unpaid bills, patient with commercial coverage: what the coverage pays or would pay, plus the patient's share.
Unpaid bills, uninsured, Medicare or Medicaid patient: 120% of the Medicare rate, or 170% of the state Medicaid rate where there is no Medicare rate.
Bills sold to a factoring company: the purchase price is admissible.
Billed amounts: reasonable billed amounts are also admissible (§ 768.0427(2)(b)5).
Future care: valued under parallel rules (§ 768.0427(2)(c)).
Provider contracts with insurers: not discoverable or admissible (§ 768.0427(2)(e)).

Medical damages may not exceed the evidence admitted under these rules. They are further capped at the sum of amounts actually paid, amounts needed to satisfy charges still owed, and reasonable future costs (§ 768.0427(4)).

After a verdict, the court also reduces the award by collateral source payments, except sources with subrogation or reimbursement rights. Medicare, Medicaid and workers' compensation are not collateral sources for this purpose (Fla. Stat. § 768.76).

Recent changes

HB 837 (2023), chapter 2023-15, was approved and took effect on March 24, 2023. According to the enrolled bill text, it:

created § 768.0427 (letter of protection disclosure, medical damages evidence and the damages cap), for cases filed after the effective date;
moved negligence actions from the 4-year to the 2-year statute of limitations (§ 95.11), for claims arising after the effective date;
added § 768.81(6): a plaintiff more than 50% at fault for their own harm recovers nothing. This does not apply to medical negligence.

The official text of § 768.0427 lists only chapter 2023-15 in its history, so we found no later amendment.

What this means for your practice

Outpatient providers have no statutory lien to file in Florida. The written letter of protection or lien agreement is what the practice relies on, and the Bar rule's duty to hold funds turns on whether applicable law gives the provider a claim.
The letter of protection, itemized and coded bills, any sale of the bill and the referral source are all disclosed in the case. A law firm's referral pattern with a provider is relevant to bias.
For a patient with commercial insurance, damages are measured by what that insurer would have paid. For uninsured, Medicare or Medicaid patients, the benchmark is 120% of Medicare or 170% of Medicaid.
In auto cases, PIP is primary. PIP bills have a 35-day billing window, and the provider may not bill the insured above the PIP fee schedule.
Negligence claims arising after March 24, 2023 have a 2-year filing deadline, which shortens case timelines.

Sources

How we verified: Florida statutes were read on the Florida Legislature's official site, HB 837 on the Florida Senate site, Rule 5-1.1 in The Florida Bar's October 2026 rules, and the Shands opinion in full text.