Chiropractic Medicine

Chiropractic services are limited to examinations, diagnoses, adjustments, manipulations and treatments of malpositioned articulations, and structures of the body provided by licensed chiropractic physicians practicing within their scope of practice.

Chiropractic x-rays used as a diagnostic tool are covered services. The services must be within the chiropractic physician’s scope of practice.

Telehealth Services

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.

Biopsychosocial Treatment of Obesity Policy Clarification

MO HealthNet coverage for biopsychosocial treatment of obesity (see Provider Bulletin Volume 44, Number 12 https://dss.mo.gov/mhd/providers/pdf/bulletin44-12.pdf) is an integrated approach to care that includes both medical nutrition therapy and behavioral health counseling to improve weight status. Prior authorization for either treatment component in isolation will not be granted.

COVID-19: Valid ICD-10 Diagnosis Code on Pharmacy Claims - Updated

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.

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

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

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.

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.