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.

2020 Provider Tips Index

COVID-19: Registered Behavior Technician - Update

September 1, 2020

On March 20, 2020, in response to the COVID-19 outbreak and due to the closure of testing centers administering the Registered Behavior Technician (RBT) exam, the MO HealthNet Division (MHD) published a provider hot tip waiving the RBT requirement for technicians who met all other requirements but had not taken the RBT exam. On July 27, 2020, the MHD published a provider hot tip to reinstate the RBT requirement. However, due to additional information regarding RBT testing delays, the MHD will continue to waive the RBT requirement for technicians who have met all other requirements but have not taken the RBT exam. The MHD’s waiver of this requirement is effective during the Public Health Emergency, beginning March 1, 2020.

The MHD has established an e-mail account for providers with questions about special accommodations and billing questions during the COVID-19 event. Please contact us at mhd.covid19@dss.mo.gov

Valid ICD-10 Diagnosis Code on Pharmacy Claims - UPDATED

August 19, 2020

On August 16, 2020, the MO HealthNet Division (MHD) began accepting ICD10 diagnosis codes on pharmacy claims. To ensure data integrity claims may be denied if the diagnosis is not coded to the highest level of specificity. When including the ICD-10 code on the pharmacy claim, the pharmacy should verify the code is billable. As an example, the code F20 Schizophrenia is a non-billable code. It lacks the full specificity needed to be billable. The list of billable ICD-10 codes for Schizophrenia is below and the exact diagnosis code should come from the prescriber of the medication. When submitting the diagnosis code in the pharmacies point of sale software the diagnosis code should be entered without the period. For the diagnosis of paranoid schizophrenia the diagnosis code should be submitted as F200.

F20.0 Paranoid schizophrenia
F20.1 Disorganized schizophrenia
F20.2 Catatonic schizophrenia
F20.3 Undifferentiated schizophrenia
F20.5 Residual schizophrenia
F20.81 Schizophreniform disorder
F20.89 Other schizophrenia
F20.9 Schizophrenia, unspecified

The submitted diagnosis code must be from the prescriber and will be subject to audit. In Missouri, pharmacists are currently not allowed to diagnose based on current rules and regulations.

Asthma Management at School – Covid-19 Response

August 4, 2020

The COVID19 pandemic presents new challenges for asthma management in the school setting, at least in the near-term. Join Missouri Telehealth Network’s Asthma Community Education (ACE) ECHO for a concise summary of how school nurses are preparing for safe and effective asthma care at school. Join the video webinar on August 11 at 12 pm. Click here for registration.

Be prepared to help school nurses provide asthma care without nebulizers.

Learn about innovations in MDI administration for both routine care and life-threatening asthma exacerbations.

On the day of the Webinar…

Sign in Early!! But only on the day of the webinar. You may join as early as 11:45 AM using the sign-in link provided above

Please fill in all fields when signing in, and click the Submit button. A new page will appear that provides the VIDEO ZOOM CONNECTION link.

Click on the VIDEO ZOOM CONNECTION link to access the ECHO webinar.

If you have any problems connecting, please contact Shelly Gooding, Telehealth and ECHO Coordinator: goodings@health.missouri.edu.

If you do not have Zoom software already downloaded, please consider downloading that ahead of time. Do download the software, go to https://zoom.us/ ; and it just takes a few minutes.

COVID-19: MEDICAID AND CHIP PROVIDER RELIEF FUND FOR MEDICAL, DENTAL AND LONG-TERM SERVICES AND SUPPORTS – Revised

August 3, 2020

This is an update to the hot tip posted on June 22, 2020.

The application deadline for the Medicaid and Chip Provider Relief Fund has been extended to August 28, 2020. Below is additional information regarding this announcement.

The U.S. Department of Health and Human Services (HHS), through the Provider Relief Fund, is distributing $15 billion to eligible Medicaid, Medicaid managed care, Children's Health Insurance Program (CHIP), and dental providers that have been impacted by the coronavirus disease 2019 (COVID-19). Eligible providers may receive up to 2 percent of reported revenue from patient care. The application deadline has been further extended to offer providers additional opportunity to apply for funding. You must act by Friday, Aug. 28, 2020 at 11:59 p.m. ET to be considered for payment from this distribution. Read more about the extension here.

Application Instructions

The application instructions and application form are available at hhs.gov/providerrelief. It is recommend providers download and review these documents to help complete the process through the Enhanced Provider Relief Fund Payment Portal. The site also includes a webcast recording, Fact Sheet, and FAQs.

Action Required

In order to apply, providers must submit their Taxpayer Identification Number (TIN) for validation through the Enhanced Provider Relief Fund Payment Portal by Aug. 28, 2020. If the results the results of that validation are received after Aug. 28, you will still be able to complete and submit your application.

Additional Information

For additional information, please call the provider support line at (866) 569-3522; for TTY, dial 711. Hours of operation are 7 a.m. to 10 p.m. Central Time, Monday through Friday. Service staff members are available to provide real-time technical assistance, as well as service and payment support.

COVID-19: Additional Albuterol Inhalers as Preferred Products - REVISED

August 3, 2020

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").

On March 20, 2020, the MHD added 2 additional albuterol inhalers to the preferred drug list for a total of 4 preferred albuterol inhalers. Effective July 9, 2020, based on feedback from manufacturers and the supply chain the MHD changed the preferred drug list to 2 preferred albuterol inhalers. The current preferred albuterol inhalers are: ProAir HFA and Proventil HFA.

COVID-19: Personal Care Program Services

July 31, 2020

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").

This is an update to guidance previously published on April 17, 2020.

Effective for dates of service on and after August 01, 2020, the following changes are made for health and welfare checks:

  • Up to five (5) hours or 20 units per month of currently authorized personal care units per participant may be utilized to complete health and welfare checks (units above the current authorization level are no longer approved).
  • Health and welfare checks are required to be billed under the participant’s current authorization for basic personal care procedure code: T1019 for Personal Care – Agency Model or T1019U2 for Personal Care – Consumer Directed Model.
  • Procedure codes T1019SC for Personal Care - Agency Model and T1019U2SC for Personal Care – Consumer Directed Model are no longer covered.

COVID-19: Sterilization Long-Acting Reversible Contraceptive (LARC) - REVISED

July 29, 2020

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").

A previous provider hot tip provided guidance stating that MO HealthNet would ensure coverage of elective sterilization procedures and Long-Acting Reversible Contraceptives (LARC) at a later date if a participant’s elective procedure was rescheduled due to COVID 19. This policy is no longer in effect, as elective procedures can now be performed. Providers should work with participants to ensure they receive these services while they are still eligible for Medicaid.

COVID-19: Registered Behavior Technician - Update

July 27, 2020

On March 20, 2020, in response to the COVID-19 outbreak and due to the closure of testing centers administering the Registered Behavior Technician (RBT) exam, the MO HealthNet Division (MHD) published a provider hot tip waiving the RBT requirement for technicians who met all other requirements but had not taken the RBT exam. Online proctored RBT testing became available in April 2020, and testing centers have since reopened with social distancing guidelines and other safety measures in place. As RBT testing is once again available, MHD will resume requiring the RBT credential for all technicians providing MHD covered ABA services, effective immediately.

Information about RBT testing is available here: https://www.bacb.com/examination-information/

MHD has established an e-mail account for providers with questions about special accommodations and billing questions during the COVID-19 event. Please contact us at mhd.covid-19@dss.mo.gov

Insurance Report Form (TPL-4)

July 23, 2020

To accomplish efforts to go paperless, effective immediately, MO HealthNet is asking all providers to submit all TPL-4 forms electronically to the Third Party Liability Unit via email to: mhd.costrecovery@dss.mo.gov.

Medicaid and CHIP Provider Relief Fund for Medical, Dental, and Long-Term Services and Supports Providers

July 22, 2020

In June, the U.S. Department of Health and Human Services (HHS) announced the opening of an application period and plans to distribute approximately $15 billion to eligible providers that participate in state Medicaid and CHIP programs who had not yet received a payment from the $50 billion General Distribution. Since the announcement on June 9, HHS has hosted a number of webinars targeted at providers and provider organizations to answer questions and assist those eligible through the application process. A fact sheet - PDF explaining the application process has also been created to address frequently asked questions. The application period has been extended to August 3, 2020. A provider may begin the application process here.

Below are some resources and information that Health Resources & Services Administration (HRSA) has on the Provider Relief Fund:

  • Program Overview:
    The bipartisan Coronavirus Aid, Relief, and Economic Security (CARES) Act and the Paycheck Protection Program and Health Care Enhancement Act provide $175 billion in relief funds to hospitals and other health care providers, including those on the front lines of the coronavirus response. A portion of these funds, under the Medicaid and Children’s Health Insurance Program (CHIP) Provider Distribution, provide help for providers and clinicians who treat our most vulnerable populations, including low-income and minority patients. This is allocated for eligible providers that participate in state Medicaid and CHIP Programs and that did not receive a payment from the Provider Relief Fund General Allocation. The payment to each provider will be approximately 2 percent of reported gross revenue from patient care.

  • Fact Sheet
    HRSA released a Fact Sheet for Medicaid and CHIP Providers that is now available on the Provider Relief Fund website.

  • Recorded Webcast
    A recording of a June 25 webcast is available at https://www.hhs.gov/coronavirus/cares-act-provider-relief-fund/for-providers/index.html.

  • Frequently Asked Questions (FAQs)
    In order to better address your most important concerns, HRSA has updated their FAQs to address common questions, including those submitted during the previous webcasts. The FAQs include expanded information on eligibility, application, payment process, and more.

  • Application Instructions
    Medicaid and CHIP Provider Distribution Instructions and the Medicaid and CHIP Provider Distribution Application Form are available at hhs.gov/providerrelief. HRSA recommends downloading and reviewing these documents to help you complete the process through the Enhanced Provider Relief Fund Payment Portal.

  • Additional Information
    For additional information, please call the Provider Support Line at (866) 569-3522; for TTY, dial 711. Hours of operation are 7 a.m. to 10 p.m. Central Time, Monday through Friday. Service staff members are available to provide real-time technical assistance, as well as service and payment support.

Backdating Provider Enrollment Applications

June 24, 2020

The Missouri Medicaid Audit and Compliance (MMAC) Provider Enrollment Unit (PEU) frequently receives requests to backdate provider enrollment applications. MMAC will not backdate the effective date of a provider’s Missouri Medicaid enrollment prior to the date MMAC received the provider’s application, except in very specific situations, such as out of state emergency services. This is outlined in state regulation.

13 CSR 65-2.020 Provider Enrollment and Application

(1) Enrollment

For any person to receive payment from the MO HealthNet Program for items or services other than out-of-state emergency services, the billing providers and the performing providers of such items or services must be enrolled providers in the MO HealthNet Program on the date the items or services are provided unless applicable rules or manuals permit enrollment as of an earlier date, up to a maximum of three hundred sixty-five (365) days prior to the actual enrollment date.

Questions regarding enrolling with the MO HealthNet program can be emailed to MMAC.ProviderEnrollment@dss.mo.gov

COVID-19: Co-Payment – Revised 06/24/20

June 24, 2020

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 with dates of service on or after January 1, 2020 and through the end of the public health emergency MO HealthNet is waiving the co-payment for ALL services.  MO HealthNet will process a mass adjustment to remove the co-payment for claims with dates of service on or after January 1, 2020.

Pharmacy shared dispensing fees are calculated by the billing provider. Pharmacies should refer to the previous pharmacy co-payment hot tips.

Providers who have collected copayments from participants for dates of service January 1, 2020 through the end of the public health emergency must refund the copayments to the participants. Shared dispensing fees should not be retroactively adjusted.

Missouri Moms and Babies Echo

June 23, 2020

The Missouri Telehealth Network in collaboration with the Missouri Hospital Association is excited to announce a new ECHO, Missouri Moms and Babies, that will begin Wednesday, June 24th from Noon to 1:00 pm! This ECHO will address challenges in perinatal care. Click here for flyer.

Initial sessions will address the COVID-19 pandemic.

June 24: Evidence-Based Highlights for Inpatient COVID Care
July 8: Outpatient Considerations for the COVID+ Obstetric Patient
July 22: Impacts on Routine Obstetrics Care during the COVID Pandemic
August 12: Having a Baby during a Pandemic: What to Expect
August 26: Care of the Newborn and Postpartum Patient with COVID
September 9: Mental Health Needs in the COVID Era

Providers interested may join the ECHO sessions on the 2nd and 4th Wednesday of each month. Register for this and other ECHOs here.

Participant Liability (Balance Billing)

June 10, 2020

Enrolled MO HealthNet providers often ask about certain situations that would make the MO HealthNet participant responsible for payment of medical services.

The guidelines for non-covered services are reflected in the Missouri Code of State Regulations 13 CSR 70-4.030 titled "Recipient Liability for Medical Services Not Reimbursable to the Provider by the Medicaid Agency".

In simple terms, this regulation states Enrolled MO HealthNet providers may NOT bill participants for covered services. The provider must accept MO HealthNet reimbursement as payment in full for provided services, even if MO HealthNet denies payment for a service for failure to follow rules and regulations of the program (such as Prior Authorization, Sterilization Consent Form, etc.).

The only exception is for services that are NOT covered by the participant’s MO HealthNet benefits. In that case, the participant may be billed if they have signed a written statement, prior to receiving the service, indicating their understanding that MO HealthNet does not cover the service and that the participant accepts financial responsibility for the service. The statement must include the date of service, the service for which the participant has accepted financial responsibility, the participant’s signature and the date signed. This should be maintained by the provider in the patient record.

A signed participant statement is not needed for systematically denied amounts reported on the provider remittance advice, such as ineligibility, limited benefits, copayment or spend down amounts.

COVID-19: Temporary Licensing for Dental Providers

June 03, 2020

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").

The Department of Commerce and Insurance, Missouri State Dental Board, filed an emergency rule to create a limited temporary dental license to allow recent dental school graduates to practice dentistry while they are waiting for clinical competency examinations to be rescheduled due to the COVID-19 pandemic. The rule was filed April 23, 2020, became effective May 7, 2020 and expires February 16, 2021. The rule can be found in its entirety at 20 CSR 2110-2.020 Limited Temporary Dental License.

In response to this emergency rule, the MHD is allowing dentists with a limited temporary license to enroll as a MO HealthNet provider. The provider’s enrollment will be made active as of the date of enrollment and will expire in accordance with the expiration date stated on the provider’s limited temporary license. Dental providers with a limited temporary license will be issued an individual NPI to be used when billing services. Dental providers with a limited temporary dental license may practice dentistry under the direct supervision of a Missouri licensed dentist. Direct supervision means the supervising dentist is physically present and remains in the treatment facility while the dental work is being performed by the limited temporary dental license holder. The supervising dentist shall check the work performed by the limited temporary dental license holder prior to the patient being discharged.

To enroll as a dental provider with the MO HealthNet program, visit the Missouri Medicaid Audit & Compliance (MMAC) web page for more information.

This Hot Tip applies to providers that wish to enroll with the MHD to provide services through the fee-for-service program. Providers wishing to enroll with the Managed Care Organizations should contact the organizations directly for their enrollment requirements.

The MHD has established an e-mail account for providers with questions about special accommodations and billing questions during the COVID-19 event. Please contact us at MHD.COVID-19@dss.mo.gov.

COVID-19: COVID Testing and Specimen Collection Codes

May 28, 2020

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").

MO HealthNet continues to monitor The Centers for Medicare and Medicaid Services (CMS) guidance related 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.

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 2/1/2020 1 $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 2/1/2020 1 $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 3/13/2020 1 $51.00
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 3/18/2020 1 $100.00
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 3/18/2020 1 $100.00
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 4/10/2020 1 $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 4/10/2020 1 $42.13

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 3/1/2020 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 3/1/2020 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 3/1/2020 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 3/1/2020 1 $25.46

COVID-19: Telehealth Services Covered for Speech Therapy, Physical Therapy and Occupational Therapy

May 21, 2020

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").

Effective immediately MO HealthNet Division has implemented Telehealth for Speech Therapy, Physical Therapy and Occupational Therapy services.

The CPT codes approved for telehealth services for Speech Therapy are:

  • 92507  treatment of speech, language, voice, and/or other communication disorder; individual
  • 92508  treatment of speech, language, voice, and/or other communication disorder; group
  • 92521  evaluation of fluency
  • 92522  evaluation of speech
  • 92523  evaluation of speech and language
  • 92524  qualitative evaluation of voice
  • 97129  cognitive function intervention, initial 15 min
  • 97130  cognitive function intervention, each additional 15 min

The CPT codes approved for telehealth services for Physical Therapy are:

  • 97110  therapeutic exercises
  • 97112  neuromuscular reeducation
  • 97116  gait training therapy
  • 97161  PT evaluation low complex 20 min
  • 97162  PT evaluation mod complex 30 min
  • 97163  PT evaluation high complex 45 min
  • 97164  PT re-evaluation established plan care

The CPT codes approved for telehealth services for Occupational Therapy are:

  • 97165  OT evaluation low complex 30 min
  • 97166  OT evaluation mod complex 45 min
  • 97167  OT evaluation high complex 60 min
  • 97168  OT re-evaluation established plan care
  • 97530  therapeutic activities
  • 97533  sensory integrative techniques, each 15 min
  • 97535  self-care management training
  • 97750  physical performance test

For additional information regarding Telehealth services during the COVID-19 pandemic, refer to the Telehealth Hot Tip located at this link.

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

MHD has established an e-mail account for providers with questions about special accommodations and billing questions during the COVID-19 event.  Please contact us at
MHD.COVID-19@dss.mo.gov.

COVID-19: Radiology (Diagnosis Codes Added),Revised May 21, 2020

May 21, 2020

COVID-19: Radiology (Diagnosis Codes Added), Revised May 21, 2020

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"). 

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.  The MHD will continue to waive the co-payment for these codes.

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/wp-content/uploads/MOHTN_PROCCODES.pdf

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

COVID-19: Long-Acting Reversible Contraceptive (LARC)

May 20, 2020

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").

During this event, if participants are unable to get a Long-Acting Reversible Contraceptive (LARC) because their procedure is rescheduled, MO HealthNet will ensure coverage of the procedure at the later date.

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

COVID-19: Pharmacy Copayment Exemption Clarification

May 15, 2020

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").

The MHD has received several inquiries from pharmacy providers regarding the hot tip "COVID-19: Pharmacy Copayment Exemption" released on May 6, 2020. The MHD does not send copay information to pharmacies in the pharmacy point of sale transaction. The switch vendor or the pharmacy’s software applies the copay. The MHD has reached out to the switch vendors and several pharmacy software vendors to alert them to the change of copays due to COVID-19. Several companies are having difficulties or are unable to make these changes. While pharmacy switch vendors and software vendors are making the necessary changes, pharmacies should waive all copays prior to dispensing MO HealthNet covered medications.

The MHD is only waiving copays during the pandemic. A hot tip will be sent to providers when to begin charging copays again.

The removal of copays does not apply to the MORx program.

COVID-19: Specimen Collection for Outpatient Services

May 14, 2020

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").

Effective with dates of services on or after March 1, 2020, MO HealthNet will cover the new specimen collection code C9803 (Hospital outpatient clinic visit specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source). This code can only be billed when provided as an outpatient service.

The MO HealthNet Division is waiving the co-payment for this code.

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

COVID-19: Home Health Program – Revised 05/15/20

(Revision to 04/17/20 Hot Tip)

May 14, 2020

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").

Beginning March 13, 2020 and until the end of the public health emergency due to COVID-19, the following changes have been implemented for the Home Health Program:

Occupational Therapists (OTs), Physical Therapists (PTs) and Speech and Language Pathologists (SLPs): OTs, PTs and SLPs may perform the initial and comprehensive assessment for all patients. The requirement that OTs, PTs and SLPs may only perform the initial and comprehensive assessment when only therapy services are ordered are waived. This modification allows an OT, PT, or SLP to perform the initial and comprehensive assessment for all patients receiving therapy services as part of the plan of care, to the extent permitted under state law, regardless of whether or not the service establishes eligibility for the patient to be receiving home care. OTs, PTs and SLPs are not permitted to perform assessments in nursing only cases. HHAs are expected to continue to match the appropriate discipline that performs the assessment to the needs of the patient to the greatest extent possible.

COVID-19: DME - Signature Requirements – Revised 05/11/20

May 11, 2020

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").

Prescription Signature

A prescription is required for Durable Medical Equipment (DME) supplies and equipment. During this event, the MHD will allow prescriptions to be accepted by telephone from the MHD enrolled ordering/prescribing physician or staff member. You must provide the full name and NPI of the physician. If the caller is someone other than the physician, you must provide the name and role of the person calling as well as the full name and NPI of the physician.

Delivery Slip Signature Requirement

Some DME is delivered to the participant’s home. The signature of the participant or their designee is currently required on the delivery slip. During this event, MO HealthNet will temporarily waive this requirement. During this event, the DME provider can document to whom the equipment was delivered. If the equipment is delivered to anyone other than the participant, document their name and relationship to the participant. A notification will be sent out reinstating the original requirement at a later date.

Certificate of Medical Necessity Form (CMN) Signature Requirement Revised April 3, 2020

Certain DME requires a Certificate of Medical Necessity Form (CMN). Original signatures are required in Field 7 and 14. Field 7 is for the ordering/prescribing physician and field 14 is for the performing DME provider who dispenses the equipment. Due to the COVID-19 outbreak MO HealthNet will temporarily waive the original signature requirement. For field 7, the physician’s order, written, electronically or by telephone, will be accepted in place of the written signature. This information should be entered in Field 7 by the DME provider. For Field 14, we will accept a typed signature by the DME provider. It does not have to be an original signature or e-signature. A notification will be sent out reinstating the original requirement at a later date.

Please note, the physician’s signature on a Prior Authorization will continue to be required.

Please contact Provider Communications at 573-751-2896 if you have additional questions. You may also send inquiries to Provider Communication via eMOMED. COVID-19 questions can be sent to mhd.covid-19@dss.mo.gov

Refer to the DME Provider Manual section 13.15.B for details on the Direct Delivery Requirements and section 7.2 for details on the CMN process.

COVID-19: Pharmacy Copayment Exemption

May 06, 2020

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 is waiving all copays, including the shared dispensing fee for pharmacy services, for the duration of the COVID-19 pandemic effective immediately. MHD has contacted the pharmacy switch vendors to modify the copay requirements. Until these changes are made pharmacies will need to manually waive copays.

On March 13, 2020, Governor Parsons issued Executive Order 20-02, which declared a State of Emergency after confirmed and/or presumptive positive cases of COVID-19 in Missouri. Governor Parsons subsequently issued Executive Order 20-04, which give the Department of Social Services authority to temporarily waive or suspend the operation of statutory rule or administrative requirements to best serve public health and safety.

Pursuant to Executive Order 20-04, the following provisions of Missouri law are being waived during the State of Emergency subject to the following restrictions/requirements:

13 CSR 70-4.051 Copayment for Pharmacy Services: All pharmacy claims shall be exempted from copayment.

COVID-19: Private Duty Nursing Services

April 29, 2020

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").

The following further clarifies the flexibility of family members and legal guardians providing private duty nursing (PDN) services published in the MO HealthNet Private Duty Nursing Services Bulletin Volume 42, No. 32 dated March 17, 2020.

  • A MO HealthNet Division enrolled PDN agency may be reimbursed for PDN services rendered by a legal guardian or family member. A family member is defined as a parent; sibling; child by blood, adoption, or marriage; spouse; grandparent or grandchild. The PDN caregiver who delivers the direct care must have a valid RN or LPN license in the State of Missouri and be employed by the MO HealthNet Division enrolled PDN provider.
  • PDN services provided by a family member or legal guardian for a single participant or multiple participants with the same residence may not exceed 12 hours per day up to a maximum of 40 hours per week. A family member or legal guardian shall not be compensated for more than 40 hours of service in a seven-day period. For a family member or legal guardian, 40 hours is the total amount allowed regardless of the number of children who receive services.

COVID-19: 1135 Waiver Implementation for Pre-Admission Screening and Resident Review (PASRR)

April 22, 2020

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"). 

Effective April 2, 2020 and through the end of the Federal Emergency Declaration, certified Skilled Nursing Facilities and Intermediate Care Facilities may follow the process outlined below for new admissions into Medicaid-certified beds.

For an applicant that may require a Level II evaluation (have a qualifying mental illness (MI) or intellectual disability (ID) diagnosis):

  • The applicant may enter the Skilled Nursing Facility (SNF) prior to completion of a Level II PASRR evaluation or Special Admission Category.
  • The hospital (or other individual completing the paperwork) will send the completed DA 124 C form to the SNF prior to discharge.  The SNF should review the client’s information to ensure the Level of Care points (24) would meet prior to admission and ensure they have enough information to determine if they can meet the medical and behavioral needs of the individual.
  • The SNF will submit the entire DA 124 application (DA 124 A/B, DA 124 C and any other supporting documentation) with a Special Admission Category form indicating “Waiver due to COVID-19” to COMRU@health.mo.gov.  The SNF should indicate if the client plans to reside at the SNF after 30 days.
  • DHSS recommends that SNFs submit the complete DA 124 application to COMRU within 14 days of admission to the SNF.
  • Once received, COMRU will determine if the applicant meets Level of Care and refer applicants requiring a Level II PASRR screening to DMH.
  • After 30 days, new admissions with mental illness (MI) or intellectual disability (ID) will receive a Resident Review as soon as resources become available.

For completed applications already submitted to COMRU for processing:

  • The applicant may enter the Skilled Nursing Facility (SNF) prior to completion of a Level II PASRR evaluation or Special Admission Category.
  • COMRU will process all pending Level II PASRR applications as Special Admission Category #5 indicating “Waiver due to COVID-19”.
  • Upon discharge, the hospital or other submitter will notify COMRU via email of the following information:  the client’s name, DCN or SSN, and the receiving SNF information (name, telephone number and fax number).
  • The hospital/submitter will ensure a copy of the DA 124 application (DA 124 A/B form and DA 124 C form) are sent to the accepting SNF prior to discharge.

The above information should be added to the DA 124 application in process and sent to DMH.  For the DA 124 applications that were already referred for Level II PASRR screening, DHSS will notify DMH and Bock & Associates via email of the individuals change in location.

The DA 124 application (DA 124 A/B form, DA 124 C form and Special Admission Category Referral form) are accessible at https://health.mo.gov/seniors/nursinghomes/pasrr.php.

MHD has established an e-mail account for providers with questions during the COVID-19 event. Please contact us at mhd.covid-19@dss.mo.gov.

Checking Eligibility

April 22, 2020

MO HealthNet would like to remind providers checking eligibility via eMOMED to wait until after 8:00 a.m. daily.

Updates to the eligibility system occur "overnight." Waiting until after 8:00 a.m. will ensure an accurate response.

COVID-19: New Laboratory Codes, updated 04/21/20

April 21, 2020

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").

MO HealthNet continues to monitor Centers for Medicare and Medicaid Services (CMS) guidance related COVID-19 testing procedures. The table below lists the COVID-19 testing procedure codes MO HealthNet currently covers as well as their effective dates, max units, and rates.

Code Description Effective with
dates of service
on or after:
Max
Units
Rate
U0001 CDC 2019 novel coronavirus (2019-ncov) real-time rt-pcr diagnostic panel 2/1/2020 1 $36.00
U0002 2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19) using any technique, multiple types or subtypes (includes all targets) 2/1/2020 1 $51.00
G2023 Specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source 3/1/2020 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 3/1/2020 1 $25.46
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 3/13/2020 1 $51.00
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. 3/18/2020 1 $100.00
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. 3/18/2020 1 $100.00

COVID-19: Personal Care Program Services

April 17, 2020

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").

The following is guidance regarding flexibilities available for State Plan Personal Care services. For more details regarding services authorized by Department of Health and Senior Services (DHSS), Division of Senior and Disability Services, please reference the DHSS/DSDS website; for questions regarding processes and services authorized by the DHSS/Division of Community and Public Health (DCPH)/Special Health Care Needs (SHCN), contact the appropriate Regional Office; and for questions regarding processes and services authorized by the DCPH/Bureau of HIV, STD and Hepatitis.

Plan of Care Tasks: Providers may limit service delivery to essential services if needed due to staffing shortages or in order to limit exposure to COVID-19. If a provider limits service delivery, they should coordinate directly with participants/caregivers to best meet their needs and preferences regarding care plan delivery.

Providers able to meet the needs of participants may deliver any necessary tasks within the total authorized unit limit, even if the specific tasks are not listed on the current care plan. The appropriate authorizing agency should only be notified if an increase in total units is needed.

Health and Welfare Checks: Providers of Personal Care services have a new option to conduct telephone checks for participants in order to ensure their health, safety and welfare during the public health emergency (i.e. additional time to go over back-up plans, checking on symptoms prior to sending an aide, general questions related to resource needs during COVID-19 and the stay-at home order, and/or the participant is refusing services due to exposure risk or there are staffing limitations so multiple phone checks are needed, etc.). These services are in addition to and not in lieu of telephone-authorized nurse visits through the Personal Care Program discussed below.

An example form developed by fellow providers is linked for providers to utilize, but is not required. Telephone checks must be documented by the provider normal timesheet guidelines. For task, indicate – telephone check.

Up to five (5) hours or 20 units per month of Personal Care can be utilized (above the normal authorization level) for each participant to complete these vital checks. To bill for this service, providers shall bill procedure codes T1019, modifier SC (agency model) and T1019, modifiers U2 & SC (CDS). The codes can be billed with from and through dates but the dates must be in same calendar month. Billing dates may not precede March 13, 2020 and must only be for documented, provided services.

Eligible Caregivers: For Personal Care agency-model providers, family members (spouse, legally responsible individuals and legal guardian excluded) may be eligible to be hired as an aide to provide care. A family member (absent the exceptions above) will only be allowed to provide services if he/she does not reside in the same residence, and he/she will only be allowed to provide services if no other caregiver is available. Family Care Safety Registry (FCSR) filing is still required (see below for further guidance).

Personal Care and Advanced Personal Care Aides: Experience/certification requirements for personal care aides and advanced personal care aides are waived.

Graduate Nurses: Graduate nurses may be hired to complete authorized nurse visits. A graduate nurse may provide services until receipt of the results of the first licensure examination taken by the graduate nurse or until ninety (90) days after graduation, whichever comes first.

Training: Training requirements are suspended for personal care and advanced personal care aides. Providers are expected to train each individual on the person-specific needs of each participant they will begin serving via telephone or other means. The training must include information on participant rights and all information regarding abuse, neglect and exploitation of participants and the importance of reporting fraudulent activities to the State.

Oversight/Evaluations: Annual oversight visit requirements and employee evaluations are suspended. The provider is still responsible to ensure staff are conducting job duties accurately and according to all programmatic rules and regulations.

Family Care Safety Registry (FCSR): The state waives the requirement for the FCSR background check to be returned prior to the start of the individual providing care as it is anticipated there may be a delay in background check processing. The provider shall file the FCSR request prior to the aide providing care, and the aide/attendant may begin providing care immediately. If a potential aide/attendant requires a Good Cause Waiver, the state will waive the requirement for the waiver to be returned prior to the individual providing care. Providers shall only make this exception for crimes that are typically waived with the Good Cause Waiver.

Advanced Personal Care Evaluation: The Authorized Nurse Visit to evaluate Advanced Personal Care may be conducted via telephone or telemonitoring. Providers are encouraged to use professional judgment to determine whether a face-to-face visit or other appropriate follow up is needed.

Medication Set Up (in home): The Center for Disease Control and Prevention (CDC) recommends individuals maintain a 14-day supply of medications. Where possible, the medication setup task through Authorized Nurse Visits may be expanded to allow for up to a 21-day supply of medications if the participant has this amount of medication supply on hand. (Note: Pharmacies must adhere to current dispensary and prescription guidance and are not able to fill more than 2 weeks in advance.)

Authorized Nurse Visits: Authorized Nurse Visits may be provided by telephone or through telemonitoring, if appropriate. Nurses must use professional judgment to determine whether a face-to-face visit is needed in order to complete the task or if it can be provided by telephone or through telemonitoring. For example, if medications have been physically set up for two or three weeks, telephone or telemonitoring can be used to check on clients on weeks that it is not necessary for the provider nurse to go to the home for medication set up. There are no set time parameters on telephone visits however, every time the nurse is conducting a nurse visit no matter what the reason for the visit is, the nurse needs to be checking on the participant as a whole utilizing the sample triage form or a similar form for documentation

Provider Operations: Provider offices can close and staff may work remotely. Providers shall maintain phone availability to ensure participants, caregivers, and the State Agency personnel or designees are able to communicate with the provider regarding participant needs.

NOW STATEWIDE! --Missouri Child Psychiatry Access Project

April 09, 2020

Are you a Missouri Primary Care Provider who has wished for a curbside consultation with a child and adolescent psychiatrist to support better outcomes for your young patients with behavioral health issues? NOW WITH STATEWIDE IMPLENTATION of MO-CPAP, your telephone can become the tool to make that happen.

The Missouri Child Psychiatry Access Project (MO-CPAP) started as a pilot program in 2018. In January 2020, it moved to statewide implementation. Initially funded by Missouri Foundation for Health (MFH) with expansion resources provided by Health Resources and Services Administration (HRSA), MO-CPAP aims to support and strengthen primary care providers’ ability to offer mental health care to young patients with mild to moderate behavioral health issues.

Primary care physicians, family physicians, pediatricians, physician assistants and advanced practice nurses can enroll in the project. Enrolled providers are available to access support services such as:

  • Telephone consults with child and adolescent psychiatrists regarding screening, diagnosis and management of behavioral health issues,
  • Linkage and referral services to connect patients to community-based mental health care and other resources, as well as telephonic follow up coordination to ensure successful connection to care,
  • Education and training in identification, assessment and treatment of mild to moderate behavioral health issues.

MO-CPAP is excited to offer MO HealthNet child providers in every Missouri County the opportunity to participate. Simply enroll online and use the consultation warm line to reach our team of child and adolescent psychiatrists and follow up coordinator, who are trained in collaborative care with the goal to increase positive outcomes for behavioral health issues. For more information about the project, or to enroll, visit MO-CPAP’s website https://medicine.missouri.edu/mo-cpap

COVID-19: Claims for MO HealthNet Participants with Medicare or Commercial Insurance

April 07, 2020

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").

MO HealthNet has recently increased flexibilities related to telehealth due to the public health emergency. In some cases MO HealthNet policies may not align with other payers’ policies.

Providers should continue to follow the regular billing process for participants who have a primary payer such as Medicare or another commercial insurance carrier. Providers should continue to submit claims to the participant’s primary payer before submitting any claims to MO HealthNet, in accordance with Section 208.215, RSMo.

COVID-19: EPSDT – Well-Child Care Visits via Telehealth

April 03, 2020

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").

Effective March 1, 2020, MHD will allow providers to bill and receive reimbursement for EPSDT services including well-child care visits via telehealth (this includes visits over the telephone) during the COVID-19 crisis. Providers should continue to use appropriate modifiers. POS 02 should be included on all telehealth claims.

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

COVID-19: Private Duty Nursing (PDN)

April 02, 2020

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").

In addition to the changes indicated in the MO HealthNet Private Duty Nursing Services Bulletin Volume 42, No. 32 dated March 17, 2020, effective immediately and until the end of the public health emergency due to COVID-19, the following additional changes are implemented for private duty nursing services:

Assistant Nursing Supervisor

An LPN with three (3) years’ experience may act as the assistant supervisor under the RN supervisor. One (1) year of experience must be in high acuity pediatric nursing care in a hospital, home care agency or residential setting. The assistant nursing supervisor may be responsible for case conferences with staff nurses, documenting the conferences, developing plan of care after the initial plan of care has been established by an RN, training and evaluation of direct care staff and other duties delegated by the Nursing Supervisor.

TB Testing

Centers for Disease Control guidelines regarding tuberculosis (TB) screening, testing, treatment and education are to be followed. (The current requirement is to perform annual TB testing.)

COVID-19: CPAP and BiPAP/Sleep Studies Criteria

April 01, 2020

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").

Sleep Studies

During this event, the MHD will cover non facility-based, non-attended Polysomnographic studies (95800, 95801 and 95806).

CPAP/BiPAP

During this event, the MHD will not require facility-based, technologist-attended sleep studies/titration study trials as part of the criteria for CPAPs (E0601) and BIPAPs (E0470, E0471). Providers must still obtain pre-certification for these DME items by calling the DME Pre-Certification Hotline (800-392-8030 option 2).

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

COVID-19: Sedative Hypnotic Preferred Drug List

March 27, 2020

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").

During this event, the MHD will maintain the current clinical criteria for the Sedative Hypnotic Preferred Drug List. The MHD had previously planned to implement significant utilization management changes to the Sedative Hypnotic Preferred Drug List. However, in order to minimize provider burden and disruption to patient care during the COVID 19 pandemic, the MHD will delay implementation of the new criteria until July 2020.

A copy of the current criteria, and future criteria, is available on the MO HealthNet Pharmacy Clinical Edits and Preferred Drug Lists website, located at: https://dss.mo.gov/mhd/cs/pharmacy/pages/clinedit.htm.

Missouri receives approval from the Centers of Medicare & Medicaid Services of 1135 waiver request related to COVID-19

March 26, 2020

On March 13, 2020, the President of the United States issued a proclamation that the COVID-19 outbreak in the United States constitutes a national emergency. On the same day, the Secretary of the United States Department of Health and Human Services invoked his authority to waive or modify certain requirements to ensure that sufficient health care items and services are available to meet the needs of individuals enrolled in Medicaid and the Children’s Health Insurance Program (CHIP). This waiver also ensures that health care providers that furnish such items and services in good faith may be reimbursed for those items and services.

This authority took effect at 6PM Eastern Standard Time on March 15, 2020, with a retroactive effective date of March 1, 2020. The emergency period will terminate, and section 1135 waivers will no longer be available, upon termination of the public health emergency, including any extensions.

Missouri submitted their request for flexibility or waiver of several requirements on March 20, 2020 and received approval from CMS on March 25, 2020. https://dss.mo.gov/covid-19/pdf/cms-approval-letter-for-waiver-1135.pdf

The areas of flexibility or waiver requested focused on strengthening the healthcare workforce, flexibility in some Emergency Medical Treatment and Labor Act (EMTALA) regulations, removing barriers to the delivery of health care services, removing restrictions to payment limitations to providers, and, removing restrictions to provider enrollment and revalidation efforts. Additionally, flexibility in waiving certain prior authorization requirements, waiver of timely filing requirements, flexibilities related to appeals and State Fair Hearings, waiver of public notice requirements, waiver of implementation of some performance deadlines, and flexibility with critical access and alternative setting requirements were requested.

Missouri anticipates further approvals by CMS under this and other authorities in the coming days.

COVID-19: Telehealth – REVISED March 26, 2020

March 23, 2020

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").

MO HealthNet covers Telehealth services. MO HealthNet allows any licensed health care provider, enrolled as a MO HealthNet provider, to provide telehealth services if the services are within the scope of practice for which the health care provider is licensed. The services must be provided with the same standard of care as services provided in person.

Telehealth services may be provided to a MHD participant, while at home, using their telephone. The originating site facility fee cannot be billed to MO HealthNet when the originating site is the participant’s home.

There is not a separate telehealth fee schedule. Reimbursement to health care providers delivering the medical service at the distant site is equal to the current fee schedule amount for the service provided.

Please find information regarding Telehealth billing and reimbursement here: https://dss.mo.gov/mhd/providers/pdf/bulletin41-20-2018.pdf. You can also view the Missouri Telehealth law here: 191.1145, 191.1146, 208.670, and 208.677.

Newly added (03/23/2020): Hospitals may bill a facility fee for distant site services provided in their facilities. The distant site service must be reported on the UB04 claim form with the procedure code, GT modifier, and zero billed charges. The billed charges for the facility fee must be billed on a separate line of the claim. The physician providing the service will still bill for their distant site services on the medical claim form.

RHCs may use either their RHC provider number or their non-RHC provider number when operating as a distant site. Please find information regarding RHC billing for Telehealth here: https://dss.mo.gov/mhd/providers/pdf/bulletin41-44_3-19.pdf.

RHCs, both Provider Based and Independent, billing for distant site services on a UB04 claim form must include the GT modifier on their claim.

During this event, the MHD is:

  • Waiving the requirement that physicians must have an established relationship with the patient before providing services via telehealth.
  • Waiving the co-payment for any services provided by means of Telehealth.
  • **Allowing the use of telephone for telehealth services.
  • **Allowing quarantined providers and/or providers working from alternate sites or facilities to provide and bill for telehealth services. These services should be billed as distant site services using the physician’s and/or clinic provider number.
  • Waiving the requirement that, in order to treat patients in this state with telemedicine or telehealth, health care providers shall be fully licensed to practice in this state. MHD will allow providers to bill for telehealth services as long as they are licensed in the state in which they practice.
  • **Providers must still be enrolled as MHD providers through Missouri Medicaid Audit and Compliance (MMAC).

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

**Clarified 3/26/20

COVID-19: Sterilization

March 25, 2020

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").

MO HealthNet participants who are pregnant women may elect to have a tubal ligation ("elective sterilization") and this is a covered service. During this event, if a participant's elective sterilization procedure is rescheduled, MO HealthNet will ensure coverage of the surgery at the later date.

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

COVID-19: MO HealthNet providers providing services at additional locations

March 24, 2020

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 and Missouri Medicaid Audit and Compliance (MMAC) do not require performing providers to receive approval to provide MHD covered services to MHD enrolled participants in different facilities or at different sites. MHD will reimburse providers for services provided at different facilities and different site. Providers should continue to bill the way they currently bill.

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

COVID-19: Multi-Function Ventilator, March 23, 2020

March 23, 2020

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

During this event, MHD will allow temporary coverage and reimbursement for a multi-function ventilator, HCPCS code E0467 with a restriction specifically for the ventilator. For participants ages 20 and under, this will be administered through the Healthy Children and Youth (HCY) program using HCPCS code E1399EPRR. For participants 21 and older, the request must be made through Exceptions process using HCPCS code E0467UBRR. Reimbursement is $1001.46 per month.

COVID-19 - Teledentistry

March 23, 2020

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").

MO HealthNet covers Teledentistry services. MO HealthNet allows any licensed dental provider, enrolled as a MO HealthNet provider, to provide Teledentistry services if the services are within the scope of practice for which the dental provider is licensed. The services must be provided with the same standard of care as services provided in person.

Teledentistry services may be provided to a MHD participant, while at home, using their telephone. The originating site facility fee cannot be billed to MO HealthNet when the originating site is the participant’s home.

The CDT codes approved for Teledentistry are:

  • D9995 Teledentistry – synchronous; real time encounter. Reported in addition to other procedures (e.g., diagnostic) delivered to the patient on the date of service; and
  • D9996 Teledentistry – asynchronous; information stored and forwarded to dentist for subsequent review. (Reported in addition to other procedures (e.g., diagnostic) delivered to the patient on the date of service.)

Both codes are reimbursed at a rate of $14.82.

During this event, the MHD is:

  • Waiving the requirement that providers must have an established relationship with the patient before providing services via Teledentistry.
  • Waiving the co-payment for any services provided by means of Teledentistry.
  • Allowing quarantined providers to provide Teledentistry services from their homes. These services should be billed as distant site services using the clinic’s provider number.
  • Waiving the requirement that, in order to treat patients in this state through the use of Teledentistry, providers shall be fully licensed to practice in this state. MHD will allow providers to bill for Teledentistry services as long as they are licensed in the state in which they practice.

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

MHD has established an e-mail account for providers with questions about special accommodations and billing questions during the COVID-19 event. Please contact us at mhd.covid-19@dss.mo.gov.

COVID-19 - Additional albuterol inhalers as preferred products

March 20, 2020

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").

During this event, MHD is adding two additional albuterol inhalers as preferred products. The list of preferred beta adrenergic short acting inhalers is:

  • ProAirâ HFA
  • Proventilâ HFA
  • Ventolinâ HFA
  • Xopenex HFAâ

MHD is currently completing system work for these to process without a call to the helpdesk, which should be completed by the end of the day on March 20, 2020.

COVID-19: Registered Behavior Technician

March 20, 2020

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").

The MHD recognizes that testing centers that administer the test required for the Registered Behavior Technician® credential are closed as of March 16, 2020 due to COVID-19.

During this event, MHD will waive the RBT requirement for technicians who meet all other requirements but have not yet taken the RBT exam. Technicians must work under the supervision of a licensed behavior analyst and the supervisory relationship must be documented in writing.

MHD has established an e-mail account for providers with questions about special accommodations and billing questions during the COVID-19 event. Please contact us at mhd.covid-19@dss.mo.gov

COVID-19: Pharmacy Signature Log Requirement

March 20, 2020

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").

For Pharmacy claims, MO HealthNet requires documentation of “offer to counsel” and also requires maintenance of a signature log to prove the prescription was delivered and received.  This requirement is in section 13.11.B of the MO HealthNet Pharmacy Provider Manual.

During this event, the MHD will allow pharmacies to document in the signature log that the participant was not required to sign, in order to practice social distancing due to COVID-19.

COVID-19: E-Prescribing

March 19, 2020

MO HealthNet has received several questions regarding telephoning a prescription for controlled substances due to the COVID19 Pandemic.

E-Prescribing is allowed for all schedules if in compliance with BNDD/DEA requirements.

The requirements of a telephoned controlled substance prescription are BNDD/DEA requirements and are not under the authority of MO HealthNet. For your reference, the requirements are below for a CII prescription to be called in to a pharmacy:

§1306.11 Requirement of prescription.

(d) In the case of an emergency situation, as defined by the Secretary in §290.10 of this title, a pharmacist may dispense a controlled substance listed in Schedule II upon receiving oral authorization of a prescribing individual practitioner, provided that:

(1) The quantity prescribed and dispensed is limited to the amount adequate to treat the patient during the emergency period (dispensing beyond the emergency period must be pursuant to a paper or electronic prescription signed by the prescribing individual practitioner);

(2) The prescription shall be immediately reduced to writing by the pharmacist and shall contain all information required in §1306.05, except for the signature of the prescribing individual practitioner;

(3) If the prescribing individual practitioner is not known to the pharmacist, he must make a reasonable effort to determine that the oral authorization came from a registered individual practitioner, which may include a callback to the prescribing individual practitioner using his phone number as listed in the telephone directory and/or other good faith efforts to insure his identity; and

(4) Within 7 days after authorizing an emergency oral prescription, the prescribing individual practitioner shall cause a written prescription for the emergency quantity prescribed to be delivered to the dispensing pharmacist. In addition to conforming to the requirements of §1306.05, the prescription shall have written on its face “Authorization for Emergency Dispensing,” and the date of the oral order. The paper prescription may be delivered to the pharmacist in person or by mail, but if delivered by mail it must be postmarked within the 7-day period. Upon receipt, the dispensing pharmacist must attach this paper prescription to the oral emergency prescription that had earlier been reduced to writing. For electronic prescriptions, the pharmacist must annotate the record of the electronic prescription with the original authorization and date of the oral order. The pharmacist must notify the nearest office of the Administration if the prescribing individual practitioner fails to deliver a written prescription to him; failure of the pharmacist to do so shall void the authority conferred by this paragraph to dispense without a written prescription of a prescribing individual practitioner.

(5) Central fill pharmacies shall not be authorized under this paragraph to prepare prescriptions for a controlled substance listed in Schedule II upon receiving an oral authorization from a retail pharmacist or an individual practitioner.

For further guidance, please contact BNDD at bndd@health.mo.gov or DEA at ODLP@usdoj.gov.

COVID-19: New email address for Providers

March 18, 2020

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").

An email address has been set up for provider questions related to billing for COVID-19 testing, treatment, services provided via telehealth, etc.

MO HealthNet will respond to these questions and track the inquiries to compile FAQ’s that will be posted on the Education/Training webpage.

Email: MHD.COVID-19@dss.mo.gov

Expedited Enrollment Processing

March 18, 2020

To expedite provider enrollment into the MO HealthNet program (Missouri's Medicaid program), Missouri Medicaid Audit & Compliance (MMAC) is providing same day or overnight approvals of most new provider enrollment applications for physicians, advanced practice nurses, and other licensed practitioners. Visit https://mmac.mo.gov/providers/ for more information.

COVID-19: Radiology

March 17, 2020

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").

The MHD’s Radiology Benefit Manager is currently auto approving Chest CT Scan HCPCS codes 71250, 71260, and 71270 when the following COVID-19 related diagnosis codes are present: B34.2, B97.29, J20.8, J22, J40, J80, J98.8, Z03.818, and Z20.828. The prior authorizations for these tests will be approved for 90 days.

The MHD is working to update the claims processing system to waive the prior authorization requirements for these tests when the above diagnosis codes are present. Providers must continue to submit prior authorization requests by using the web tool, Cyber Access, or by calling the MO HealthNet Call Center at (800) 392-8030, option 5, until the system work to waive the prior authorization requirements is complete.

The MO HealthNet Division is also waiving the co-payment for these codes.

COVID-19: Telehealth for Behavioral Health Providers (including Counseling/Psychology and ABA providers)

March 17, 2020

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").

MO HealthNet covers Telehealth services. Please find information regarding Telehealth here: https://dss.mo.gov/mhd/providers/pdf/bulletin41-20-2018.pdf. You can also view the Missouri Telehealth law here: 191.1145, 191.1146, 208.670, and 208.677.

During this event, the MHD is allowing telehealth services to be provided to a MHD participant, while at home, using their telephone.

There is not a separate telehealth fee schedule. Reimbursement to health care providers delivering behavioral health services at the distant site is equal to the current fee schedule amount for the service provided.

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

Adult Exceptions and DME supplies

March 16, 2020

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").

In an effort to help contain the spread of the virus, temporary measures will be in place immediately to ensure our participants can still receive necessary items.

Effective immediately, prescribers seeking requests and/or renewal of Durable Medical Equipment (DME) items via Exceptions, Pre-Certification, and/or Prior Authorization may utilize face-time and/or telephone calls in place of a face-to-face office visit. 

  • Prescribers are still required to document the telephone encounter in the participant’s medical record and include notes regarding medical necessity of the items.
  • Prescribers must still complete an Exception Request form for items, as well as call the DME Pre-Certification Hotline (800-392-8030 option 2) for pre-certed items, or a DME Prior Authorization form submitted per protocol for requests of items.

If you have any questions, please call Provider Communications at 573-751-2896.

COVID-19: Provider Information (Physicians, Medical Clinics, FQHC’s, RHC’s) - Corrected

March 16, 2020

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").

The Department of Health & Senior Services (DHSS) webpage has the most current and comprehensive information.  DHSS’ 24 hour hotline is (877) 435-8411.  Please continue to review this information regularly.

MO HealthNet will conduct a webinar for Physicians/Medical Clinics, FQHC’s, RHC’s on March 18, 2020 at 10:30 a.m.  You may register here

This webinar will address billing, telehealth and resources.

COVID-19:  Laboratory

March 16, 2020

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").  MO HealthNet providers who test patients for COVID-19 may bill using the newly created HCPCS codes U0001 and U0002.

HCPCS code U0001 is used specifically for CDC testing laboratories to test patients for SARS-CoV-2.  The rate for U0001 is $36.00.  HCPCS code U0002 allows laboratories to bill for non-CDC laboratory tests for SARS-CoV-2.  The rate for U0002 is $51.00.

The MO HealthNet Division is waiving the co-payment for these codes.

The MO HealthNet claims processing system will accept these codes on April 1, 2020 for dates of service on or after February 4, 2020.

COVID-19

March 9, 2020

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").  MO HealthNet providers who test patients for COVID-19 may bill using the newly created HCPCS codes U0001 and U0002.

HCPCS code U0001 is used specifically for CDC testing laboratories to test patients for SARS-CoV-2.  HCPCS code U0002 allows laboratories to bill for non-CDC laboratory tests for SARS-CoV-2.

The MO HealthNet claims processing system will accept these codes on April 1, 2020 for dates of service on or after February 4, 2020.

Click here for more information on coronavirus from Department of Health & Senior Services.

Date Change: MO HealthNet Behavioral Health Provider Workshop

March 4, 2020

The MO HealthNet Division has changed the date of the provider workshop that was to be held on April 29, 2020 in order to avoid a conflict with the 2020 Missouri Children’s Trauma Network Training Summit. The behavioral health workshop will now be held on May 12, 2020.

The ABA workshop will still be held on April 16, 2020.

If you have questions about registration you can contact Constituent Education at MHD.provtrain@dss.mo.gov or 573-751-6683.

Complementary Health and Alternative Therapies for Chronic Pain Management: Pre-Certification Process and Billing

February 24, 2020

On April 1, 2019, the MO HealthNet Division (MHD) implemented statewide Complementary Health and Alternative Therapy Services for Chronic Pain Management.

The Complementary Health and Alternative Therapy Services program includes a combination of newly covered services: physical therapy, chiropractic therapy, and acupuncture, along with current coverage of cognitive-behavioral therapy (CBT) and non-opioid medication therapy.

Pre-certification of physical therapy, chiropractic therapy, and acupuncture services is a two-step process:

  1. The provider that prescribes the physical therapy, chiropractic, or acupuncture service must initiate the precertification process.
  2. The “performing provider” that will perform the service must access the precertification to complete the second step.
    • If the performing provider is part of a clinic or facility, the group (billing) NPI must be used in step 2.  The group (billing) NPI must be used to bill the claim as well. 
    • The individual performing provider NPI must be entered in performing provider field on eMOMED.

To obtain pre-certification, enrolled providers can call 800-392-8030, and choose Option 6, or use CyberAccess, a web tool that automates this process for MO HealthNet providers.
If you are not a CyberAccess user, contact the help desk at 888-581-9797 or 573-632-9797, or email cyberaccesshelpdesk@conduent.com to set up an account.

An approved pre-certification request does not guarantee payment. Providers must verify participant eligibility on the date of service by using the Interactive Voice Response (IVR) System at (573) 751-2896 or by utilizing eMOMED.

Providers that submit orders, prescriptions or referrals for Medicaid participants must have an active enrollment status with MO HealthNet in order for the billing provider’s claim to be approved. This is very important.  All ordering, referring, or prescribing providers are required by state and federal regulation to be enrolled with MHD.

  • For participants enrolled as members in a Managed Care health plan, providers will need to contact the member’s MO HealthNet Managed Care health plan directly for questions regarding their pre-certification procedures.

On January 1, 2020, MHD started covering chiropractic services for all MHD participants. These services are separate from the chiropractic services offered in the Complementary Health and Alternative Therapies for Chronic Pain Management program.  See this bulletin for information about these chiropractic services.

Physician & Laboratory Responsibilities for Drug Screening Services Billed to MO HealthNet: Reminders

February 11, 2020

The MO HealthNet Division (MHD) covers qualitative (presumptive) and semi-quantitative drug screening tests.  These tests report what drug classes (e.g., tricyclic antidepressants, phenothiazines, amphetamines, benzodiazepines, barbiturates, cannabinoids, methadone, opiates) are present (qualitative) and may provide an estimate (semi-quantitative) of the concentration.

MHD only covers quantitative (definitive) or “confirmative” tests if there is a positive screen for the drug class to be quantified and if the physician has documented the medical necessity in the patient medical record.

Physician offices or clinics may bill for initial drug screens performed at the point of care or independent and/or hospital laboratories may bill for screenings they perform.  Both providers cannot bill for the same date of service for the same participant.

The ordering physician has certain responsibilities:

  • The ordering physician must coordinate the billing of the drug screen tests with the performing laboratory. 
  • The ordering physician must document medical necessity in the patient medical record when ordering quantification of a drug class or a confirmatory drug test. 
  • The ordering physician must sign each order for drug screening tests by signing a paper order, or by electronic signature that conforms with the requirements of 13 CSR 65-3.050.  The requirements state that an electronic signature means a computer data compilation of any symbol or series of symbols executed, adopted, or authorized by an individual with the intent to be the legally binding equivalent of the individual’s handwritten signature. The use of biometrics does not constitute an electronic signature; however, biometrics may be used as part of electronic signature verification. A signature stamp does not constitute an electronic signature.

The performing laboratory has certain responsibilities:

  • The performing laboratory must ensure the physician has provided documentation of medical necessity when requesting quantification of a drug class or a confirmatory drug test.
  • The performing laboratory must not perform quantification of a drug class or a confirmatory drug test without documentation of medical necessity.

Diabetes Training Opportunity for Behavioral Health Providers!

February 3, 2020

We are alerting you to a world-class behavioral health training for psychologists and other mental health professionals developed by the American Diabetes Association on Saturday, February 29, 2020, in Kansas City. The workshop is co-sponsored by the Missouri Psychological Association (MOPA) and the Kansas City University of Medicine and Biosciences.

ABOUT THE WORKSHOP: Lead speaker will be Dr. Doug Tynan, former Director of the Office of Integrated Care for APA and now with the American Diabetes Association. He will be accompanied by two other nationally recognized instructors in this area.

The workshop is offering a total of 12 CEs --- 7 at the workshop and 5 more online.

COSTS/REGISTRATION: Regular cost of the workshop is $295, but MOPA or Kansas Psychological Association members will receive a special $45 discount. You may find out more at www.mopaonline.org/diabetes.

WHY THIS WORKSHOP IS IMPORTANT: The CDC reports that more than 100 million Americans are now living with diabetes or pre-diabetes. It is the 7th leading cause of death in our country. Behavioral health issues are common.

Given the right education and background, there is a special place for psychologists and behavioral health professionals who wish to provide care to this group and a special opportunity to expand your practice.

Laboratory Panel Codes

January 7, 2020

The MO HealthNet Division (MHD) claims processing system can only process claims for laboratory panels if all of the procedure codes and units that are included in the panel are completed and submitted on the electronic claim.

For example, the laboratory panel for procedure 80426 includes four units of 83001 and four units of 83002.  The provider must complete four units of 83001 and four units of 83002 in order to bill for 80426.  This claim can be submitted electronically.

If a provider only completes one unit of 83001 and one unit of 83002 they cannot bill 80426.  The claim for one unit of 83001 and one unit of 83002 must be submitted via paper claim to:

Department of Social Services
Attn:  Lab/Transplant Unit
PO Box 6500
Jefferson City MO  65102

Provider Resources for Bereavement Training

January 3, 2020

There are several bereavement training opportunities offered by Share (Pregnancy & Infant Loss Support).  Available are eight online training courses.  Live presentations of Companion training and Memory Making are scheduled in February 2020.

Trainings are all available free of charge from a Missouri Foundation for Health grant.  If you are interested in hosting a training or for further information, please email:  companion@nationalshare.org

To access these online learning courses: https://education.nationalshare.org/bundles/advanced-training-courses

Medicare Beneficiary Identification Number (MBI)

January 1, 2020

All Medicare claims submitted after January 1, 2020, are required to use the new MBI number. Effective January 1, 2020, claims filed without the MBI will deny for a mismatch of DCN/MBI combination not found in the MMIS.

The Medicare Access and CHIP Reauthorization Act (MACRA) required CMS to remove Social Security Numbers (SSNs) from the current SSN-based Health Insurance Claim Number (HICN)

Missouri Dual eligible Medicaid and Medicare participants have received their new cards.

If you have questions please call Provider Communications at 573-751-2896.