Effective July 1, 2022, MO HealthNet Division (MHD) implemented changes to maximum daily quantities for certain procedure codes. MHD’s fee schedules will continue to show the previous maximum daily quantity until July 1, 2024. This is to allow claims for dates of service prior to July 1, 2022 to pay correctly. Claims for dates of service July 1, 2022 and forward with units above the new maximum daily quantity will deny. For any questions, please contact Provider Communications using the Provider Management tool on eMOMED or by calling (573) 751-2896.
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UNIT AND DAILY MAXIMUM QUANTITY CHANGES |
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Through 06/30/2022 |
Effective 07/01/2022 |
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Proc Code |
Description |
Unit |
Daily |
Unit |
Daily |
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90791 |
Psych Diagnostic Eval |
30 min |
6 |
Untimed |
1 |
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90792 |
Psych Diagnostic Eval with Medical |
30 min |
6 |
Untimed |
1 |
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90853 |
Group psychotherapy |
30 min |
3 |
Untimed |
1 |
|
90839 |
Psychotherapy for crisis |
60 min |
6 |
60 min |
1 |
|
96105 |
Assessment of aphasia |
60 min |
4 |
60 min |
3 |
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96116 |
Neurobehavioral status exam |
60 min |
4 |
60 min |
1 |
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96146 |
Automated psych or neuropsych testing and result |
Untimed |
4 |
Untimed |
1 |
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DAILY Maximum Quantity Changes |
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Through 06/30/2022 |
Effective 07/01/2022 |
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Proc Code |
Description |
Unit |
Daily |
Unit |
Daily |
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97151 |
Behavior identification assessment |
15 min |
8 |
15 min |
32 |
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97152 |
Behavior identification supporting assessment |
15 min |
32 |
15 min |
16 |
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97155 |
Adaptive behavior treatment with protocol modification |
15 min |
32 |
15 min |
24 |
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97156 |
Family adaptive behavior treatment guidance |
15 min |
40 |
15 min |
16 |
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0362T |
Behavior identification supporting assessment, 2 or more techs |
15 min |
32 |
15 min |
16 |
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0373T |
Adaptive behavior treatment with protocol modification, 2 or more techs, for destructive behavior |
15 min |
34 |
15 min |
32 |