Date

Effective for dates of service on or after 7/1/2021, MO HealthNet will allow Hospital & Clinic providers to bill for an inhaler if the participant is diagnosed with COVID or the participant has been exposed to COVID-19, and the facility is awaiting test results.

  • The claim must include the primary diagnosis code U07.1 (COVID-19) or Z20.822 (Contact with and (suspected) exposure to COVID-19).
  • The participant must be given the inhaler to take home to avoid refill too soon rejections at the hospital, clinic, and pharmacy.
  • This coverage exception is limited to the following classes of inhalers: Short-Acting Beta-Adrenergic Agents, COPD Anticholinergic Agents, and Oral Inhaled Corticosteroids.
  • MO HealthNet has preferred drug lists for most inhalers before utilizing an inhaler. MO HealthNet recommends checking the preferred drug list. Non-preferred products require prior authorization on or before the date of service. MO HealthNet’s current preferred inhalers are available through the searchable database: https://pdlsearchabledatabase.pharmacy.services.conduent.com/.
  • MO HealthNet will not reimburse hospital & clinic providers for inhalers if the claim lacks an approvable diagnosis.
  • MO HealthNet will only reimburse inhalers billed with the correct NDC units (for example, a standard ProAir HFA inhaler is 8.5 grams)
  • If the visit extends across multiple dates of service, MO HealthNet will only pay for 1 (one) of each inhaler for the full visit. Claims billed for multiple of the same inhaler will be subject to audit and potential recoupment.
  • Drug claims from non-pharmacy providers must still be billed as a one-day supply.
  • The coverage of take-home inhalers due to COVID-19 is a time-limited exception to MO HealthNet’s policy on take-home drugs and supplies. Providers will be notified by Hot Tip prior to this exception expiring. For more information on the Take-Home Drugs and Supplies policy, please see section 13.49 of the MO HealthNet Hospital Provider Manual.