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.
The Women’s Health Services program, Medicaid Eligibility (ME) code 80 and 89, is a limited benefit program. Please refer to the Provider Bulletin, Women’s Health Services, which shows that services and supplies are only covered for the primary purpose of family planning or when a family-related problem was identified and/or diagnosed during a routine family planning visit.
The Centers for Medicare & Medicaid Services (CMS) recently announced the official compliance date of October 1, 2015, for implementation of the International Classification of Diseases, Tenth Edition (ICD-10). ICD-10 will have an effect on all medical and hospital claims that contain a diagnosis, and will be required for all providers covered by the Health Insurance Portability Accountability Act of 1996 (HIPAA). All healthcare professionals and facilities must be aggressively involved and develop a plan of action in order to be successful.
The Missouri Code of State Regulations 13 CSR 70-3.190 Telehealth Services, established coverage for Telehealth Services through the MO HealthNet Division (MHD) program and specifies that Telehealth providers must be Missouri licensed. The provider can be located in a state that borders Missouri, but must be Missouri licensed and enrolled as a MHD provider.
With the ICD-10 implementation date of October, 1, 2014, quickly approaching, MO HealthNet would like to extend an invitation to providers to complete the ICD-10 Clinical Survey.
Physician practices MUST begin using the ICD-10 codes by Oct. 1, 2014. The Missouri State Medical Association (MSMA) and Kansas Medical Society will be hosting an ICD-10 educational series by conference call. No registration is required for these free sessions which will be from 12:00 PM to 1:00 PM on February 27, 2014; March 6, 2014; and March 13, 2014.
Providers should develop a plan of action now in order to succeed with ICD-10. Your organization must identify available resources, assess training needs, build a training plan, and manage productivity during the transition process. During the transition, it will also be necessary to provide additional time for the coders to code. There are several free online resources available for implementing ICD-10, such as the Centers for Medicare and Medicaid Services (CMS). CMS provides a helpful ICD-10 planning checklist and frequently asked questions for providers.
Currently, the United States uses the ICD code set, Ninth Edition (ICD-9), originally published in 1977. Since implementation of ICD-9, the medical field has undergone much advancement in diagnosis and treatment, and more codes are needed than ICD-9 can provide. The ICD code set, Tenth Edition (ICD-10) will be implemented on October 1, 2014. ICD-10 will provide the much needed space for expansion of codes, more specific data than ICD-9, and will better reflect current medical practice.
Diabetes self-management training services are not available to adults receiving a limited benefit package. If the service is non-covered for a participant due to their benefit package, the service may be requested through the Exceptions Process program prior to the service being provided. Information related to the Exceptions Process can be found on the Exceptions Process web page.
On October 1, 2014, the ICD-9 code sets used to report medical diagnoses and inpatient procedures will be replaced by ICD-10 code sets.
Centers for Medicare and Medicaid Services (CMS) has stated that the October 1, 2014 date is the date of conversion to ICD-10.
CMS Resources that may be helpful are:
