MO HealthNet will be offering webinars related to Telehealth billing. If you are a Telehealth provider or biller, please take advantage of a webinar to answer any questions you might have and gain information on billing Telehealth claims to MO HealthNet.
You may sign up for a webinar under Training Information on the MO HealthNet Provider Information Page/Education.
Effective February 1, 2016, the MO HealthNet Division (MHD) will no longer require precertification for the following echocardiography procedure codes:
The purpose of this hot tip is to provide further clarification on allowable ME codes for physicians providing obstetrical services to Medicaid Pregnant Women (MPW).
In addition to the commonly used ME 18, ME 43, ME 44, ME 45, and ME 61, the following ME Codes are also allowable for payment:
After December 31, 2014, there will no longer be enhancement payments for MO HealthNet program providers that participate in the primary rate increase.
If you have questions concerning this announcement, please reference the Provider Bulletin, Volume 35, No. 31 Physician Primary Care Rate Increase For Certain Services.
Hyperbaric Oxygen Therapy (HBO) is only payable as a professional component charge using CPT code 99183. Please reference the MO HealthNet Division (MHD) Fee Schedule and Physician Manual, Section 13.61, to determine current reimbursement rate and units allowed.
Per the Physician Manual, Section 13.60, diabetes self-management training services are used in the management and treatment of type 1, type 2 and gestational diabetes. These services are covered, when prescribed by a physician or a health care professional with prescribing authority and may be provided by a Certified Diabetes Educator (CDE), Registered Dietician (RD) or Registered Pharmacist (RPh).
Procedure code 99050, "Services provided in the office at times other than regularly scheduled office hours, or days when the office is normally closed," may be billed in addition to the appropriate procedure code for the service, for those services provided before or after the physician's designated office hours. "Designated office hours" are defined as those hours known and understood by the public as times the office is regularly open for business.
Per Physician Manual, Section 13.57.B, routine ultrasounds are not indicated in normal pregnancies. However, MO HealthNet reimbursement is available for up to three ultrasound procedures during any one rolling year, when reasonable and necessary based on medical indication(s).
As announced in the June 12, 2014, Volume 36, No. 31, Physician Bulletin, effective June 15, 2014, MO HealthNet will pay for elective circumcisions for all newborn infants less than 28 days old using Current Procedural Terminology (CPT) codes 54150 and 54160.
Reconstructive breast surgery is considered a MO HealthNet covered service, if necessary to restore symmetry as recommended by the oncologist or primary care physician for the patient incident to mastectomy, as well as other documented medical necessity deemed appropriate via MO HealthNet physician consultant review.
