The MO HealthNet Division publishes Hot Tips to supply information to clarify and assist in receiving timely reimbursement for services provided and claims disposition.

MO HealthNet has developed an index for historical and ongoing Hot Tips and a COVID-19 index for associated Hot Tips. The non-COVID-19 index location has not moved; it is also located below for quick reference.   Please share these Hot Tips with your billing staff.

Correct Address for Mailing Paper Dental Claim Forms

April 12, 2021

MO HealthNet dental providers submitting paper dental claim forms for MO HealthNet fee-for-service participants, must mail claims to:

Wipro Infocrossing
P.O. Box 5600
Jefferson City, MO 65102

Paper claims sent to any other address will not be processed for payment. For additional information, reference Section 15.7 of the Dental Manual at http://manuals.momed.com/manuals/.

COVID-19: COVID Testing and Specimen Collection Codes – REVISED

March 24, 2021

The MO HealthNet Division (MHD) is responding to an outbreak of respiratory disease caused by a novel (new) coronavirus.  The virus has been named "SARS-CoV-2" and the disease it causes has been named "coronavirus disease 2019" (abbreviated "COVID-19"). 

MHD continues to monitor the Centers for Medicare and Medicaid Services (CMS) guidance related to COVID-19 testing and specimen collection.  The tables below list the COVID-19 testing and specimen collection procedure codes MO HealthNet currently covers as well as who can bill each code, effective dates, max units, and rates. 

Effective for dates of service on or after March 1, 2020, and through the end of the public health emergency, claims submitted by independent laboratories for COVID-19 testing will not require a referring physician.  Providers that perform other laboratory services on the same date as the COVID-19 test must bill for the COVID-19 test on a separate claim in order to be reimbursed.  MO HealthNet will recycle all claims submitted by independent laboratories for COVID-19 tests that did not include a referring provider.

Effective for dates of service on or after January 1, 2021, pharmacists and pharmacies are included in the providers that can bill COVID-19 testing codes.

Effective for dates of service on or after January 1, 2021, providers can bill COVID-19 testing code U0005 in addition to either HCPCS code U0003 or U0004 only after receiving results within two calendar days from date and time of specimen collection.

COVID-19 Testing Codes

Code

Description

Who can bill this code?

Effective with dates of service on or after:

Max Units

Rate

U0001

CDC 2019 novel coronavirus (2019-ncov) real-time rt-pcr diagnostic panel

Providers with the appropriate CLIA Certificate type for the test

02/01/2020

2

$36.00

U0002

2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19) using any technique, multiple types or subtypes (includes all targets)

Providers with the appropriate CLIA Certificate type for the test

02/01/2020

2

$51.00

87635

Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique

Providers with the appropriate CLIA Certificate type for the test

03/13/2020

2

$51.00

86328

Immunoassay for infectious agent antibody(ies), qualitative or semiquantitative, single step method (e.g., reagent strip); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]).

Providers with the appropriate CLIA Certificate type for the test

04/10/2020

3

$45.23

86769

Antibody; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]).

Providers with the appropriate CLIA Certificate type for the test

04/10/2020

3

$42.13

87426

Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative, multiple-step method; severe acute respiratory syndrome coronavirus (eg, SARS-CoV, SARS-CoV-2 [COVID-19]).

Providers with the appropriate CLIA Certificate type for the test

06/25/2020 – 01/24/2021

01/25/2021

3

$45.23

$35.33

86408

Neutralizing antibody, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]); screen

Providers with the appropriate CLIA Certificate type for the test

08/10/2020

1

$42.13

86409

Neutralizing antibody, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]); titer

Providers with the appropriate CLIA Certificate type for the test

08/10/2020

1

$79.61

86413

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), antibody, quantitative

Providers with the appropriate CLIA Certificate type for the test

09/08/2020

3

$51.43

87636

Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) and influenza virus types A and B, multiplex amplified probe technique

Providers with the appropriate CLIA Certificate type for the test

10/06/2020

3

$142.63

87637

Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), influenza virus types A and B, and respiratory syncytial virus, multiplex amplified probe technique

Providers with the appropriate CLIA Certificate type for the test

10/06/2020

3

$142.63

87811

Infectious agent antigen detection by immunoassay with direct optical (ie, visual) observation; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19])

Providers with the appropriate CLIA Certificate type for the test

10/06/2020

3

$41.38

87428

Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzymelinked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; severe acute respiratory syndrome coronavirus (eg, SARS-CoV, SARS-CoV-2 [COVID-19]) and influenza virus types A and B

Providers with the appropriate CLIA Certificate type for the test

11/10/2020

1

$63.59

U0003

Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique, making use of high throughput technologies as described by CMS-2020-01-R.

Providers with the appropriate CLIA Certificate type for the test

03/18/2020 – 12/31/2020

01/01/2021

2

$100.00

$75

U0004

2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19), any technique, multiple types or subtypes (includes all targets), non-CDC, making use of high throughput technologies as described by CMS-2020-01-R.

Providers with the appropriate CLIA Certificate type for the test

03/18/2020 – 12/31/2020

01/01/2021

2

$100.00

$75

U0005

Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique, CDC or non-CDC, making use of high throughput technologies, completed within two calendar days from date and time of specimen collection.

Providers with the appropriate CLIA Certificate type for the test

01/01/2021

1

$25

COVID-19 Specimen Collection Codes

Code

Description

Who can bill this code?

Effective with dates of service on or after:

Max Units

Rate

99211

Medicare suggests using the Level 1 evaluation and management code for assessment and specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source

Physician office

03/01/2020

1

$15.31

C9803

Hospital outpatient clinic visit specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source

Hospital outpatient department

03/01/2020

1

Percent of billed charges

G2023

Specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source

Independent Laboratories

03/01/2020

1

$23.46

G2024

Specimen collection for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), from an individual in a skilled nursing facility or by a laboratory on behalf of a home health agency, any specimen source

Independent Laboratories

03/01/2020

1

$25.46

Quantity Prescribed Requirement

February 24, 2021

The final rule CMS-0055-F from the U.S. Department of Health and Human Services requires the reporting of the NCPDP Quantity Prescribed (460-ET) field for all Schedule II drugs on pharmacy claims as of September 21, 2020.

The MO HealthNet Division (MHD) completed system work to deny claims if the NCPDP Quantity Prescribed (460-ET) field is not populated for Schedule II drugs. Claims will deny with a reject code of ET - M/I Quantity Prescribed if the field is blank, has all zeros, or is missing. Pharmacies should work with their software vendors to capture the mandatory NCPDP Quantity Prescribed (460-ET) field on all Schedule II drug claims.

Pharmacy Early Refill

February 18, 2021

Effective February 18, 2021, MO HealthNet is changing the early refill policy for medications to 85% for controlled and non-controlled substances. Providers may contact the Pharmacy Help Desk at (800) 392-8030 option 3 if overrides are needed.

COVID-19: Radiology (Diagnosis Codes Added effective January 1, 2021)

January 19, 2021

The MO HealthNet Division (MHD) is responding to an outbreak of respiratory disease caused by a novel (new) coronavirus.  The virus has been named "SARS-CoV-2" and the disease it causes has been named "coronavirus disease 2019" (abbreviated "COVID-19").

As posted in the 05/21/2020 hot tip, effective with dates of service on or after March 1, 2020 providers do not need to obtain prior authorization for Chest CT Scan HCPCS codes 71250, 71260, and 71270 when the following COVID-19 related diagnosis codes are present: B34.2, B97.29, J12.89, J20.8, J22, J40, J80, J96.00, J96.01, J96.02, J96.20, J96.21, J96.22, J98.8, P22.0, P28.5, R05, R06.02, R09.02, R50.9, Z03.818, Z09, Z20.828, and Z86.19.  Effective January 1, 2021 the following COVID-19 related diagnosis codes have been added:  Z11.52, Z20.822, Z86.16, M35.81, M35.89 and J12.82. The MHD will continue to waive the co-payment for these procedures.

Prior authorizations for ALL procedures managed by the MHD’s Radiology Benefit Manager (RBM) will be approved for 90 days during the COVID-19 crisis. The list of procedures the RBM manages can be found here: https://www.healthhelp.com/wpcontent/uploads/MOHTN_PROCCODES.pdf

This Hot Tip also applies to providers that are contracted with the Managed Care Organizations.

Logisticare Solutions, LLC Changes Name to ModivCare Solutions, LLC

January 13, 2021

Effective January 6, 2021, MO HealthNet’s Non-Emergency Medical Transportation (NEMT) vendor for fee-for-service participants changed its name from LogistiCare Solutions, LLC to ModivCare Solutions, LLC as part of a company rebranding initiative.  Modiv is Latin for “way”, and reflects the company’s desire to lead innovation and change in terms of how people connect to care.  The new name will not change any of the services provided.

Other changes as part of the rebrand include:

  • Company logo and colors
  • The way staff answers the phone - for members’ consideration, staff will answer the phone as ModivCare, formerly LogistiCare, for 12 months following the transition.
  • Company website - for members’ consideration, the website will reference ModivCare, formerly LogistiCare, for 12 months following the transition.

What is not changing as part of the rebrand:

  • Phone numbers and the way clients, members, facilities and transportation providers contact them.
  • Their staff will remain the same.
  • The way members book their rides online – members will continue to use the same links to schedule their rides as they have been.

ModivCare’s purpose of this rebrand is to shift toward becoming a tech-enabled, value-based healthcare company that will translate into better member experience that delivers consistent, positive healthcare outcomes and leads the industry into a new era.

COVID-19: COVID-19 Testing for participants with Extended/Uninsured Women’s Health Services

January 12, 2021

The MO HealthNet Division is responding to an outbreak of respiratory disease caused by a novel (new) coronavirus. The virus has been named "SARS-CoV-2" and the disease it causes has been named "coronavirus disease 2019" (abbreviated "COVID-19").

Effective for dates of service on or after March 1, 2020, and through the end of the public health emergency, MO HealthNet will cover COVID-19 testing for participants with Extended/Uninsured Women’s Health Services benefits. Providers who perform other services on the same date as the COVID-19 test for these participants must bill for the COVID-19 tests on a separate claim in order to be reimbursed.