PACE Benefit Table
Program of All-Inclusive Care for the Elderly (PACE) Benefit Table
The Program of All-Inclusive Care for the Elderly (PACE) is administered by MO HealthNet and Medicare to provide comprehensive health care, social, recreational, and wellness services to its participants. One of the main goals of PACE is to allow older adults to live safely in their homes instead of nursing facilities. As of May 3, 2024, PACE organizations are active in St. Louis and Kansas City, with a new PACE organization coming to the Springfield area later this year.
Multi-Test Laboratory Panels
Multi-Test Laboratory Panels
Refer to the Current Procedural Terminology (CPT) book for the appropriate procedure codes for multi-test laboratory panels. The panel components are not intended to limit the performance of other tests. If medically necessary additional tests are performed in addition to those specifically indicated for a particular panel, those tests may be billed separately in addition to the panel code. In order to bill a panel procedure code, it is required that all indicated components in a panel test be performed on the same date of service.
Physician & Laboratory Responsibilites for Drug Screening Services Billed to MO HealthNet: Reminders
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.
Laboratory Panel Codes
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.
Provider Based Rural Health Clinics Billing Laboratory and Radiological Services
Provider-based Rural Health Clinics (RHC) should not bill the MO HealthNet Division (MHD) for the technical component of laboratory and radiological services. Section 13.1.B of the RHC manual states the technical component of laboratory and radiology are not RHC services.