Date
Not all MO HealthNet Division (MHD) participants are eligible for Dentures. Dentures are a covered benefit for the following MHD participants:
- Pregnant Women, Medical Eligibility (ME) codes 18, 43, 44, 45, and 61
(MHD Managed Care health plans are responsible for coverage of dentures for pregnant members with these same ME codes) - Eligible participants through one of the assistance categories for the blind, ME codes 02, 03, 12, and 15.
- Eligible participants residing in a nursing home with verification of vendor care/nursing home eligibility are determined by checking for “Nursing Home Information” when verifying participant eligibility on emomed.
- Participants under the age of 21.
Dentures are not covered for participants with a limited benefit package. A complete list of ME codes for participants receiving limited benefits can be found on the ‘MO HealthNet Guide – Puzzled by the Terminology’ document. Please reference the Benefit Matrix to determine the ME codes and benefits for each of the MHD programs.
When submitting claims for dentures to MO HealthNet, the date of service is the date of placement. Dentures, full or partial, do not require prior authorization.