Benefit Tables
Master List of Covered Services
As of 12/05/2025
Coverage Group: | Blind Programs | Breast or Cervical Cancer Control Program (BCCCP) | Children's Programs | CHIP Kids | Missouri RX Plan (MORx) | MO HealthNet for Adults | MO HealthNet for Kids | MO HealthNet for Pregnant Women | Presumptive Eligibility for Children | Program of All-Inclusive Care for the Elderly (PACE)* | Qualified Medicare Beneficiary (QMB) | Temporary Women's Assistance for Pregnant Women | Traditional Medicaid | Uninsured Women's Health Services |
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ME Code(s): | 02, 03, 12, 15 | 83, 84 | 23, 28, 33, 34, 41, 49, 67, 88 | 71, 72, 73, 74, 75, 97, 9S | 82 | 05, E2 | 06, 07, 08, 29, 30, 36, 37, 38, 40, 50, 52, 56, 57, 60, 62, 64, 65, 66, 68, 69, 70, 4M,6S,0F,5A | 18, 43, 44, 45, 61, 95, 96, 98 | 87 | 01, 03, 04, 11, 12, 13, 14, 15, 16, 85, 86, E2 | 55 | 58, 59, 94 | 01, 04, 11, 13, 14, 16, 81, 85, 86 | 80, 89 |
Applied Behavior Analysis (ABA) | Limited (1) | Limited (1) | Limited (1) | Limited (1) | No | Limited (1) | Limited (1) | Limited (1) | Limited (1) | Yes | Limited (16) | No | Limited (1) | No |
Ambulance (Emergency only) | Yes | Yes | Yes | Yes | No | Yes | Yes | Yes | Yes | Yes | Limited (16) | Limited (2) | Yes | No |
Ambulance - Treat No Transport (TNT) | Yes | Yes | Yes | Yes | No |
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| Limited (16) |
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Ambulatory Surgical Center | Yes | Yes | Yes | Yes | No |
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| Limited (16) |
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Biopsychosocial Treatment for Obesity | Yes | Yes | Yes | Yes | No |
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| Limited (16) |
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Certified Nurse Practitioner | Yes | Yes | Yes | Yes | No |
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| Limited (16) |
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Chiropractic Medicine | Yes | Yes | Yes | Yes | No |
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| Limited (16) |
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Community Psychiatric Rehabilitation | Limited (13) | Yes | Yes | Yes | No |
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| Limited (16) |
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Complementary & Alternative Therapies for Chronic Pain Management | Yes | Yes | No | No | No |
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| Limited (16) |
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Comprehensive Day Rehabilitation | Yes | Limited (4) | Yes | Yes | No |
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| Limited (16) |
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Comprehensive Substance Treatment & Rehabilitation (CSTAR) | Limited (13) | Yes | Yes | Yes | No |
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| Limited (16) |
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Dental | Yes | Limited (17) | Yes | Yes | No |
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| Limited (16) |
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Diabetes Prevention Program | Yes | Yes | No | No | No |
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| Limited (16) |
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Diabetes Self-Management | Yes | Limited (4) | Yes | Yes | No |
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| Limited (16) |
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Doula | Yes | Yes | Yes | Yes | No |
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Durable Medical Equipment | Yes | Yes | Yes | Yes | No |
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Environmental Lead Assessments | Limited (4) | Limited (4) | Yes | Yes | No | Limited (4) |
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Family Planning | Yes | Yes | Yes | Yes | No |
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Habilitative Therapy; Occupational, Physical & Speech | No | No | No | No | No |
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Hearing Aid | Yes | Yes | Yes | Yes | No |
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Home Health | Yes | Limited (18) | Yes | Yes | No |
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Hospice | Yes | Yes | Yes | Yes | No |
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Hospital - Inpatient | Yes | Yes | Yes | Yes | No |
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Hospital - Outpatient | Yes | Yes | Yes | Yes | No |
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Intermediate Care Facility - Intellectual Disabilities (ICF-ID) | Yes | No | Yes | No | No |
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Laboratory & Radiology | Yes | Yes | Yes | Yes | No |
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Licensed Clinical Social Worker | Yes | Yes | Yes | Yes | No |
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Licensed Marital & Family Therapist | Yes | Yes | Yes | Yes | No |
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Licensed Professional Counselor | Yes | Yes | Yes | Yes | No |
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