The Centers for Medicare & Medicaid Services has approved the MO HealthNet Division (MHD) state plan amendment for the July 1, 2022 provider rate increase. The claims processing system has been updated with the new maximum allowable reimbursement rates. MHD will reprocess claims paid for dates of service on or after July 1, 2022. However, MHD will not reprocess any claims billed with units that exceed the new daily maximum quantity. Providers will need to adjust any claims that require changes to quantity of units billed.
Please refer to the below provider bulletins for details on changes to unit definitions and daily maximum quantities effective July 1, 2022.
- Rate Update for Behavioral Health Services - Revised (Volume 45 Number 08)
- Physical, Occupational, and Speech Therapy Rate and Quantity (Volume 45 Number 12)
- Rate Update for Audiology Services (Volume 45 Number 14)
- National Correct Coding Initiative (NCCI) Medically Unlikely Edits (MUE) (Volume 45 Number 19)
(Please note, for some procedure codes the fee schedule will not reflect the MUE daily maximum quantities. This is to allow for ongoing billing at the previous quantities for dates of services prior to July 1, 2022.)
Claims billed with charges less than the updated maximum allowable rate will reimburse no more than the billed charges. If appropriate, providers may file adjustments to update billed charges.
For questions regarding rate increases, please contact the MHD Education and Training unit at MHD.ProvTrain@dss.mo.gov or (573)751-6683.