The Department of Health and Senior Services (DHSS) Extended Women’s Health Services (WHS) Program covers specific services for uninsured women ages 18 to 55 (Medicaid Eligibility code 89) with a Modified Adjusted Gross Income (MAGI) for the household size that does not exceed 201% of the federal poverty level. Refer to the General Sections Manual for more information.
For a claim to be reimbursed through the WHS Program, providers—including laboratory and radiology providers—must ensure that both the procedure code and the diagnosis code are listed below as covered.
If a service is billed with a code (either diagnosis or procedure) that is not included in the WHS covered list, the claim will not be reimbursed by the MO HealthNet Division (MHD).
- Procedure Codes
Proc Code Description 00851 ANESTHESIA TUBAL LIGATION 00952 ANESTHESIA HYSTEROSCOPE/GRAPH 11976 REMOVE CONTRACEPTIVE CAPSULE 11981 INSERTION DRUG DELIVERY IMPLANT 11982 REMOVE DRUG IMPLANT DEVICE 11983 REMOVE/INSERT DRUG IMPLANT 56501 DESTROY VULVA LESIONS, SIMPLE 56820 EXAM OF VULVA W/SCOPE 56821 EXAM/BIOPSY OF VULVA W/SCOPE 57420 EXAM OF VAGINA W/SCOPE 57421 EXAM/BIOPSY OF VAGINA W/SCOPE 57452 EXAM OF CERVIX W/SCOPE 57454 BIOPSY/CURETT OF CERVIX W/SCOPE 57455 BIOPSY OF CERVIX W/SCOPE 57456 ENDOCERVICAL CURETTAGE W/SCOPE 57460 BIOPSY OF CERVIX W/SCOPE LEEP 57461 CONIZATION OF CERVIX W/SCOPE LEEP 57465 COMPUTER-AIDED MAPPING CERVIX UTERI DURING COLPOSCOPY 57505 ENDOCERVICAL CURETTAGE (NOT DONE AS PART OF A DILATION AND CURETTAGE) 57510 CAUTERIZATION OF CERVIX ELECTRO OR THERMAL 57511 CRYOCAUTERY OF CERVIX 57513 LASER SURGERY OF CERVIX; LASER ABLATION 58300 INSERT INTRAUTERINE DEVICE 58301 REMOVE INTRAUTERINE DEVICE 58340 CATHETER FOR HYSTEROGRAPHY 58562 HYSTEROSCOPY REMOVE FOREIGN BODY 58565 HYSTEROSCOPY STERILIZATION 58600 DIVISION OF FALLOPIAN TUBE 58611 LIGATE OVIDUCT(S) ADD-ON 58615 OCCLUDE FALLOPIAN TUBE(S) 58661 LAPAROSCOPY REMOVE ADNEXA 58670 LAPAROSCOPY TUBAL CAUTERY 58671 LAPAROSCOPY TUBAL BLOCK 74740 X-RAY FEMALE GENITAL TRACT 74742 X-RAY FALLOPIAN TUBE 76830 TRANSVAGINAL ULTRASOUND NON-OB 76831 ECHO EXAM UTERUS 76856 ULTRASOUND EXAM PELVIC, COMPLETE 76857 ULTRASOUND EXAM PELVIC, LIMITED 80047 METABOLIC PANEL IONIZED CALCIUM 80048 METABOLIC PANEL TOTAL CALCIUM 80051 ELECTROLYTE PANEL 80055 OBSTETRIC PANEL 80074 ACUTE HEPATITIS PANEL 81000 URINALYSIS NON-AUTOMATED W/SCOPE 81001 URINALYSIS AUTOMATED W/SCOPE 81002 URINALYSIS NON-AUTOMATED W/O SCOPE 81003 URINALYSIS AUTOMATED W/O SCOPE 81005 URINALYSIS 81015 MICROSCOPIC EXAM OF URINE SPECIMEN 81020 URINALYSIS GLASS TEST 81025 URINE PREGNANCY TEST 82105 ALPHA-FETOPROTEIN SERUM 82120 AMINES VAGINAL FLUID QUALITATIVE 82306 VITAMIN D 25 HYDROXY 82465 ASSAY BLOOD/SERUM CHOLESTEROL 82670 ASSAY OF TOTAL ESTRADIOL 82671 ASSAY OF ESTROGENS, FRACTIONS 82672 ASSAY OF ESTROGENS, TOTAL 82677 ASSAY OF ESTRIOL 82679 ASSAY OF ESTRONE 82947 ASSAY GLUCOSE BLOOD, QUANTITATIVE 82948 GLUCOSE; BLOOD, REAGENT STRIP 82962 GLUCOSE BLOOD TEST, FINGERSTICK METHOD 83001 ASSAY OF GONADOTROPIN (FSH) 83002 ASSAY OF GONADOTROPIN (LH) 84144 ASSAY OF PROGESTERONE 84146 ASSAY OF PROLACTIN 84478 ASSAY OF TRIGLYCERIDES 84702 CHORIONIC GONADOTROPIN TEST 84703 CHORIONIC GONADOTROPIN ASSAY 85004 AUTOMATED WBC COUNT 85007 BLOOD SMEAR W/DIFF WBC COUNT 85008 BLOOD SMEAR W/O DIFF WBC COUNT 85009 MANUAL DIFF WBC COUNT B-COAT 85013 SPUN MICROHEMATOCRIT 85014 HEMATOCRIT 85018 HEMOGLOBIN 85025 COMPLETE CBC W/AUTOMATED DIFF WBC 85027 COMPLETE CBC AUTOMATED 85032 MANUAL CELL COUNT EACH 85041 AUTOMATED RBC COUNT 85045 AUTOMATED RETICULOCYTE COUNT 85048 AUTOMATED LEUKOCYTE COUNT 85060 BLOOD SMEAR, PERIPHERAL, INTERPRETATION BY PHYSICIAN WITH WRITTEN REPORT 85610 PROTHROMBIN TIME 85652 RBC SEDIMENTATION RATE AUTOMATED 85660 RBC SICKLE CELL TEST 85730 THROMBOPLASTIN TIME PARTIAL 86318 IMMUNOASSAY INFECTIOUS AGENT ANTIBODY 86382 NEUTRALIZATION TEST VIRAL 86386 NUCLEAR MATRIX PROTEIN 22 86403 PARTICLE AGGLUT ANTBODY SCREEN 86580 TB INTRADERMAL TEST 86592 SYPHILIS TEST NON-TREPONEMAL QUALITATIVE 86593 SYPHILIS TEST NON-TREPONEMAL QUANTITATIVE 86628 CANDIDA ANTIBODY 86631 CHLAMYDIA ANTIBODY 86632 CHLAMYDIA IGM ANTIBODY 86687 HTLV-I ANTIBODY 86688 HTLV-II ANTIBODY 86689 HTLV/HIV CONFIRM ANTIBODY 86694 HERPES SIMPLEX NES ANTIBODY 86695 HERPES SIMPLEX TYPE 1 TEST 86696 HERPES SIMPLEX TYPE 2 TEST 86701 HIV-1 ANTIBODY 86702 HIV-2 ANTIBODY 86703 HIV-1/HIV-2 1 RESULT ANTIBODY 86704 HEP B CORE ANTIBODY TOTAL 86705 HEP B CORE ANTIBODY IGM 86706 HEP B SURFACE ANTIBODY 86707 HEPATITIS B E-ANTIBODY 86708 HEPATITIS A ANTIBODY 86762 RUBELLA ANTIBODY 86780 TREPONEMA PALLIDUM 86787 VARICELLA-ZOSTER ANTIBODY 86803 HEPATITIS C AB TEST 86900 BLOOD TYPING SEROLOGIC ABO 86901 BLOOD TYPING SEROLOGIC RH(D) 87015 SPECIMEN INFECTIOUS AGENT CONCENTRATION 87040 BLOOD CULTURE FOR BACTERIA 87070 CULTURE OTHR SPECIMEN AEROBIC 87071 CULTURE AEROBIC QUANT OTHER 87073 CULTURE BACTERIA ANAEROBIC 87075 CULTR BACTERIA EXCEPT BLOOD 87076 CULTURE ANAEROBE IDENTIFY EACH 87077 CULTURE AEROBIC IDENTIFY 87081 CULTURE SCREEN ONLY 87086 URINE CULTURE/COLONY COUNT 87088 URINE BACTERIA CULTURE 87102 FUNGUS ISOLATION CULTURE 87106 FUNGI IDENTIFICATION YEAST 87110 CHLAMYDIA CULTURE 87147 CULTURE TYPE IMMUNOLOGIC 87164 DARK FIELD EXAMINATION 87184 MICROBE SUSCEPTIBLE DISK 87186 MICROBE SUSCEPTIBLE MICRODILUTION 87205 SMEAR GRAM STAIN 87206 SMEAR FLUORESCENT/ACID STAIN 87207 SMEAR SPECIAL STAIN 87210 SMEAR WET MOUNT SALINE/INK 87220 TISSUE EXAM FOR FUNGI 87252 VIRUS INOCULATION TISSUE 87255 GENET VIRUS ISOLATE HSV 87270 CHLAMYDIA TRACHOMATIS ANTIGENS IMMUNOFLUORESCENT 87273 HERPES SIMPLEX 2 ANTIGENS IMMUNOFLUORESCENT 87274 HERPES SIMPLEX 1 ANTIGENS IMMUNOFLUORESCENT 87320 CHLAMYDIA TRACHOMATIS ANTIGEN IMMUNOASSAY 87340 HEPATITIS B SURFACE ANTIGEN IMMUNOASSAY 87350 HEPATITIS B E-ANTIGEN IMMUNOASSAY 87389 HIV-1 ANTIGEN W/HIV-1&-2 AB ANTIGEN IMMUNOASSAY 87390 HIV-1 ANTIGEN IMMUNOASSAY 87391 HIV-2 ANTIGEN IMMUNOASSAY 87480 CANDIDA DNA DIRECT PROBE 87481 CANDIDA DNA AMPLIFIED PROBE 87482 CANDIDA DNA QUANTITATIVE 87485 CHLAMYDIA PNEUMONIAE DNA DIRECT PROBE 87486 CHLAMYDIA PNEUMONIAE DNA AMPLIFIED PROBE 87487 CHLAMYDIA PNEUMONIAE DNA QUANTITATIVE 87490 CHLAMYDIA TRACHOMATIS DNA DIRECT PROBE 87491 CHLAMYDIA TRACHOMATIS DNA AMPLIFIED PROBE 87492 CHLAMYDIA TRACHOMATIS DNA QUANTITATIVE 87495 CYTOMEGALOVIRUS DNA DIRECT PROBE 87496 CYTOMEGALOVIRUS DNA AMPLIFIED PROBE 87497 CYTOMEGALOVIRUS DNA QUANTITATIVE 87510 GARDNERELLA VAGINALIS DNA DIRECT PROBE 87511 GARDNERELLA VAGINALIS DNA AMPLIFIED PROBE 87512 GARDNERELLA VAGINALIS DNA QUANTITATIVE 87522 HEPATITIS C, INCLUDES REVERSE TRANSCRIPTION 87528 HERPES SIMPLEX VIRUS (HSV) DNA DIRECT PROBE 87529 HSV DNA AMPLIFIED PROBE 87530 HSV DNA QUANTITATIVE 87531 HUMAN HERPES VIRUS (HHV-6) DNA DIRECT PROBE 87532 HHV-6 DNA AMPLIFIED PROBE 87533 HHV-6 DNA QUANTITATIVE 87534 HIV-1 DNA DIRECT PROBE 87535 HIV-1 PROBE, INCLUDES REVERSE TRANSCRIPTION 87536 HIV-1 QUANTITATIVE, INCLUDES REVERSE TRANSCRIPTION 87537 HIV-2 DNA DIRECT PROBE 87538 HIV-2 PROBE, INCLUDES REVERSE TRANSCRIPTION 87539 HIV-2 QUANTITATIVE, INCLUDES REVERSE TRANSCRIPTION 87590 NEISSERIA GONORRHOEAE DNA DIRECT PROBE 87591 NEISSERIA GONORRHOEAE DNA AMPLIFIED PROBE 87592 NEISSERIA GONORRHOEAE DNA QUANTITATIVE 87623 HPV LOW-RISK TYPES 87624 HPV HIGH-RISK TYPES 87625 HPV TYPES 16 & 18 ONLY 87634 RSV DNA/RNA AMPLIFIED PROBE 87653 STREP B DNA AMPLIFIED PROBE 87660 TRICHOMONAS VAGINALIS DIRECT PROBE 87661 TRICHOMONAS VAGINALIS AMPLIFIED 87797 DETECT AGENT NOT OTHERWISE SPECIFIED DNA DIRECT 87800 DETECT AGENT MULT DNA DIRECT 87801 DETECT AGENT MULT DNA AMPLIFIED 87808 TRICHOMONAS ASSAY W/OPTICAL 87810 CHLAMYDIA TRACHOMATIS ASSAY W/OPTICAL 87850 NEISSERIA GONORRHOEAE ASSAY W/OPTICAL 88108 CYTOPATHOLOGY CONCENTRATE TECHNIQUE 88141 CYTOPATHOLOGY CERVICAL OR VAGINAL INTERPRET 88142 CYTOPATHOLOGY CERVICAL OR VAGINAL THIN LAYER 88143 CYTOPATHOLOGY CERVICAL OR VAGINAL THIN LAYER REDO 88147 CYTOPATHOLOGY CERVICAL OR VAGINAL AUTOMATED 88148 CYTOPATHOLOGY CERVICAL OR VAGINAL AUTOMATED RESCREEN 88150 CYTOPATHOLOGY CERVICAL OR VAGINAL MANUAL 88152 CYTOPATHOLOGY CERVICAL OR VAGINALAUTOMATED REDO 88153 CYTOPATHOLOGY CERVICAL OR VAGINALREDO 88155 CYTOPATHOLOGY CERVICAL OR VAGINAL INDEX ADD-ON 88160 CYTOPATHOLOGY SMEAR OTHER SOURCE 88161 CYTOPATHOLOGY SMEAR OTHER SOURCE 88162 CYTOPATHOLOGY SMEAR OTHER SOURCE 88164 CYTOPATHOLOGY TECHNICAL LAB TEST, CERVICAL OR VAGINAL MANUAL 88165 CYTOPATHOLOGY TECHNICAL LAB TEST, CERVICAL OR VAGINAL REDO 88166 CYTOPATHOLOGY TECHNICAL LAB TEST, CERVICAL OR VAGINAL AUTOMATED REDO 88167 CYTOPATHOLOGY TECHNICAL LAB TEST, CERVICAL OR VAGINAL SELECT 88172 CYTOPATHOLOGY DIAGNOSIS EVALUATION FINE NEEDLE ASPIRATE 1ST EA SITE 88173 CYTOPATHOLOGY EVALUATION FINE NEEDLE ASPIRATE REPORT 88174 CYTOPATHOLOGY CERVICAL OR VAGINAL AUTOMATED IN FLUID 88175 CYTOPATHOLOGY CERVICAL OR VAGINAL AUTO FLUID REDO 88300 SURGICAL PATHOLOGY, GROSS 88302 TISSUE EXAM BY PATHOLOGIST 88304 TISSUE EXAM BY PATHOLOGIST 88305 TISSUE EXAM BY PATHOLOGIST 88307 TISSUE EXAM BY PATHOLOGIST 99070 SPECIAL SUPPLIES PHYSICIAN OR QUALIFIED HEALTH PROFESSIONAL 99202 OFFICE OUTPATIENT NEW STRAIGHTFORWARD 15-29 MIN 99203 OFFICE OUTPATIENT NEW LOW 30-44 MIN 99204 OFFICE OUTPATIENT NEW MODERATE 45-59 MIN 99205 OFFICE OUTPATIENT NEW HIGH 60-74 MIN 99211 OFFICE/OTHER OUTPATIENT FOR ESTABLISHED PATIENT MAY NOT REQUIRE PHYSICIAN OR QUALIFIED HEALTH PROFESSIONAL 99212 OFFICE OUTPATIENT ESTABLISHED STRAIGHTFORWARD10-19 MIN 99213 OFFICE OUTPATIENT ESTABLISHED LOW 20-29 MIN 99214 OFFICE OUTPATIENT ESTABLISHED MODERATE 30-39 MIN 99215 OFFICE OUTPATIENT ESTABLISHED HIGH 40-54 MIN 99385 PREVENTATIVE VISIT, NEW PATIENT AGE 18-39 99386 PREVENTATIVE VISIT, NEW PATIENT AGE 40-64 99395 PREVENTATIVE VISIT, ESTABLISHED PATIENT AGE 18-39 99396 PREVENTATIVE VISIT, ESTABLISHED PATIENT AGE 40-64 A4261 CERVICAL CAP FOR CONTRACEPTIVE USE A4266 DIAPHRAGM G0307 CBC WITHOUT PLATELET J1055 MEDROXYPROGESTERONE ACETATE INJECTION J7297 LILETTA, 52 MG J7298 MIRENA, 52 MG J7300 INTRAUTERINE COPPER CONTRACEPTIVE J7301 SKYLA, 13.5 MG J7304 CONTRACEPTIVE HORMONE PATCH J7306 LEVONORGESTREL IMPLANT SYSTEM Q0111 WET MOUNTS W/ PREPARATIONS T1015 CLINIC VISIT/ENCOUNTER, ALL-INCLUSIVE - Diagnosis Codes
Diag Code Description A51.0 PRIMARY GENITAL SYPHILIS A51.1 PRIMARY ANAL SYPHILIS A51.2 PRIMARY SYPHILIS OF OTHER SITES A51.5 EARLY SYPHILIS, LATENT A51.9 EARLY SYPHILIS, UNSPECIFIED A54.00 GONOCOCCAL INFECTION OF LOWER GENITOURINARY TRACT, UNSPECIFIED A54.01 GONOCOCCAL CYSTITIS AND URETHRITIS, UNSPECIFIED A54.02 GONOCOCCAL VULVOVAGINITIS, UNSPECIFIED A54.03 GONOCOCCAL CERVICITIS, UNSPECIFIED A54.24 GONOCOCCAL FEMALE PELVIC INFLAMMATORY DISEASE A54.29 OTHER GONOCOCCAL GENITOURINARY INFECTIONS A54.31 GONOCOCCAL CONJUNCTIVITIS A54.32 GONOCOCCAL IRIDOCYCLITIS A54.33 GONOCOCCAL KERATITIS A54.39 OTHER GONOCOCCAL EYE INFECTION A54.41 GONOCOCCAL SPONDYLOPATHY A54.42 GONOCOCCAL ARTHRITIS A54.49 GONOCOCCAL INFECTION OF OTHER MUSCULOSKELETAL TISSUE A54.5 GONOCOCCAL PHARYNGITIS A54.6 GONOCOCCAL INFECTION OF ANUS AND RECTUM A54.81 GONOCOCCAL MENINGITIS A54.83 GONOCOCCAL HEART INFECTION A54.85 GONOCOCCAL PERITONITIS A54.89 OTHER GONOCOCCAL INFECTIONS A56.00 CHLAMYDIAL INFECTION OF LOWER GENITOURINARY TRACT, UNSPECIFIED A56.19 OTHER CHLAMYDIAL GENITOURINARY INFECTION A56.2 CHLAMYDIAL INFECTION OF GENITOURINARY TRACT, UNSPECIFIED A56.3 CHLAMYDIAL INFECTION OF ANUS AND RECTUM A56.4 CHLAMYDIAL INFECTION OF PHARYNX A56.8 SEXUALLY TRANSMITTED CHLAMYDIAL INFECTION OF OTHER SITES A57 CHANCROID A59.00 UROGENITAL TRICHOMONIASIS, UNSPECIFIED A59.01 TRICHOMONAL VULVOVAGINITIS A59.03 TRICHOMONAL CYSTITIS AND URETHRITIS A59.09 OTHER UROGENITAL TRICHOMONIASIS A59.8 TRICHOMONIASIS OF OTHER SITES A59.9 TRICHOMONIASIS, UNSPECIFIED A60.04 HERPESVIRAL VULVOVAGINITIS A60.09 HERPESVIRAL INFECTION OF OTHER UROGENITAL TRACT A60.9 ANOGENITAL HERPESVIRAL INFECTION, UNSPECIFIED A63.0 ANOGENITAL (VENEREAL) WARTS A63.8 OTHER SPECIFIED PREDOMINANTLY SEXUALLY TRANSMITTED DISEASES A64 UNSPECIFIED SEXUALLY TRANSMITTED DISEASE A74.81 CHLAMYDIAL PERITONITIS A74.89 OTHER CHLAMYDIAL DISEASES B07.9 VIRAL WART, UNSPECIFIED B37.0 CANDIDAL STOMATITIS B37.31 ACUTE CANDIDIASIS OF VULVA AND VAGINA B37.49 OTHER UROGENITAL CANDIDIASIS B85.2 PEDICULOSIS, UNSPECIFIED B85.3 PHTHIRIASIS B85.4 MIXED PEDICULOSIS AND PHTHIRIASIS B86 SCABIES D06.0 CARCINOMA IN SITU OF ENDOCERVIX D06.1 CARCINOMA IN SITU OF EXOCERVIX D06.7 CARCINOMA IN SITU OF OTHER PARTS OF CERVIX D06.9 CARCINOMA IN SITU OF CERVIX, UNSPECIFIED D07.0 CARCINOMA IN SITU OF ENDOMETRIUM D07.1 CARCINOMA IN SITU OF VULVA D07.2 CARCINOMA IN SITU OF VAGINA - Covered Drugs
- 2ND GEN. ANAEROBIC ANTIPROTOZOAL-ANTIBACTERIAL
- ABSORBABLE SULFONAMIDES
- AMINOGLYCOSIDES
- ANAEROBIC ANTIPROTOZOAL-ANTIBACTERIAL AGENTS
- ANTIFUNGAL AGENTS
- ANTIVIRAL, GENERAL
- BETALACTAMS
- CEPHALOSPORINS
- CEPHALOSPORINS 3RD GENERATION
- CONTRACEPTIVES, IMPLANTABLE
- CONTRACEPTIVES, INJECTABLE
- CONTRACEPTIVES, INTRAVAGINAL
- CONTRACEPTIVES, TRANSDERMAL
- DIAPHRAGMS/CERVICAL CAPS
- IMMUNOMODULATORS
- INTRA-UTERINE DEVICES
- KERATOLYTICS
- LINCOSAMIDES
- MACROLIDES
- PENICILLINS
- QUINOLONES
- TETRACYCLINES
- TOPICAL ANTIPARASITICS
- TOPICAL ANTIVIRALS
- VAGINAL ANTIBIOTICS
- VAGINAL ANTIFUNGALS
Revised 09/21/2026