During the COVID-19 public health emergency (PHE), MO HealthNet (MHD) did not require providers to obtain prior authorization for Chest CT Scan HCPCS codes 71250, 71260, and 71270 when the following COVID-19 related diagnosis codes were 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, Z86.19, Z11.52, Z20.822, Z86.16, M35.81, M35.89 and J12.82.
The COVID-19 public health emergency will expire on May 11, 2023. Effective May 12, 2023, MO HealthNet will require providers to obtain prior authorization for the above listed Chest CT Scan HCPCS codes when the above listed COVID-19 related diagnosis codes are present.
During the COVID-19 PHE, MO HealthNet also allowed prior authorizations for all procedures managed by the MHD’s Radiology Benefit Manager (RBM) to be approved for 90 days.
Effective May 12, 2023, prior authorizations for all procedure codes managed by the MHD’s Radiology Benefit Manager (RBM) will be approved for 30 days.