mydss

Fee Schedules & Rate Lists

Fee Schedules

MO HealthNet fee schedules are updated monthly.  If a procedure code reimbursement has been changed and the fee schedule has not yet been updated, MO HealthNet providers will be reimbursed at the correct updated amount. 

MO HealthNet fee schedules are categorized by provider type. However, some Current Procedural Terminology (CPT) codes may be billed by multiple provider types.

Pricing files are used by all MO HealthNet providers. A code may not be appropriate for a claim even though it is listed in a pricing file. 

HCBS 1915c Waiver Settings Statewide Transition Plan

In March 2014, the Center for Medicaid and Medicare Services (CMS) published a final rule regarding changes to Home and Community-Based Waiver Services (HCBS Waiver). The rule defines home and community-based settings and person-centered planning requirements in Medicaid HCBS Waiver programs. The rule requires demonstration of how state's HCBS Waiver programs comply with the federal HCBS rules.

Exception Process

The Exception Unit reviews requests for non-covered items and services to be covered. Under certain conditions of medical need, the MO HealthNet Division may authorize payment for a participant to receive an essential medical service or equipment that otherwise exceeds MO HealthNet benefits and limitations.

Access Monitoring Review Plan

What is the Access Monitoring Review Plan

Under Federal rule 42 C.F.R. §§447.203-204 (the Access Rule) set forth a transparent, data driven procedural process for states to demonstrate that the state’s Medicaid Fee-For-Service payments comply with the access standards in Section 1902(a)(30)(A) of the Social Security Act. The MO HealthNet Division welcomes ongoing comments related to access to care.

Comments may be sent by mail or email to:

MO HealthNet Cost Recovery

Estate Recovery Program

In certain situations, the MO HealthNet Division (MHD) is required to seek repayment of costs for healthcare services after a participant dies. This is called estate recovery. An estate can include assets owned by the participant such as a home, or savings or retirement account, etc. If the MO HealthNet participant has no assets at the time of death, there is nothing else MHD will do to collect any payments, and will not ask any living dependents for repayment.

GEMT Uncompensated Cost Reimbursement Program

What is the GEMT Program?

The Ground Emergency Medical Transportation (GEMT) Uncompensated Cost Reimbursement Program is a voluntary program that allows for the reimbursement of uncompensated costs to eligible GEMT providers who provide qualifying emergency ambulance services to MO HealthNet participants. Total reimbursement from the MO HealthNet Division (MHD), will not exceed 100% of the GEMT provider’s actual costs. Reimbursement shall be distributed to enrolled providers based on GEMT services provided to the participant on a per-transport basis.

Annual Renewal FAQs

What is an annual renewal?

An annual renewal is a process the Family Support Division (FSD) is federally required to complete that determines if a participant is still eligible for MO HealthNet (Missouri Medicaid) each year. 

Private Duty Nursing for Children FAQs

Eligibility and Limitations

To qualify for Private Duty Nursing (PDN) services, the participant must:

  • Be eligible for MO HealthNet benefits;
  • Be under the age of 21; and
  • Have a medical problem which requires at least a four-hour block of nursing care per day that exceeds the family’s ability to care for the child without help.

PDN services cannot be provided when the participant:

Spend Down FAQs

What is Spend Down?

If your income is above the limit to qualify for Missouri Medicaid (MO HealthNet) for the Aged, Blind, and Disabled, you may still be able to get MO HealthNet coverage under this category if you agree to pay, or “spend down,” a certain amount each month.

Subscribe to mydss